Healthcare Provider Details

I. General information

NPI: 1790489524
Provider Name (Legal Business Name): JACOB A MARDER, DNP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/23/2025
Certification Date: 03/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 N FLAGLER DR STE 9000
WEST PALM BEACH FL
33401-3421
US

IV. Provider business mailing address

1411 N FLAGLER DR STE 9000
WEST PALM BEACH FL
33401-3421
US

V. Phone/Fax

Practice location:
  • Phone: 561-584-8460
  • Fax: 561-935-5537
Mailing address:
  • Phone: 561-584-8460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. JACOB ARIEL MARDER
Title or Position: PRESIDENT
Credential: DNP
Phone: 561-584-8460