Healthcare Provider Details

I. General information

NPI: 1154934149
Provider Name (Legal Business Name): JACOB ARIEL MARDER DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DR. JACOB MARDER

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
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:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberAPRN11008886
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11008886
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: