Healthcare Provider Details

I. General information

NPI: 1851202667
Provider Name (Legal Business Name): MARLEY SAVAGE WIERZCHOWIEC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9461 FOREST HILLS PL
TAMPA FL
33612-7649
US

IV. Provider business mailing address

9461 FOREST HILLS PL
TAMPA FL
33612-7649
US

V. Phone/Fax

Practice location:
  • Phone: 813-340-0913
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number11045431
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: