Healthcare Provider Details

I. General information

NPI: 1689627895
Provider Name (Legal Business Name): MARIE HOLT CUPIT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 CENTRE PARK WEST DR STE 175
WEST PALM BEACH FL
33409-6466
US

IV. Provider business mailing address

2101 CENTRE PARK WEST DR STE 175
WEST PALM BEACH FL
33409-6466
US

V. Phone/Fax

Practice location:
  • Phone: 561-242-3009
  • Fax: 561-242-3010
Mailing address:
  • Phone: 561-242-3009
  • Fax: 561-690-0336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN2202832
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: