Healthcare Provider Details

I. General information

NPI: 1154257798
Provider Name (Legal Business Name): MARIE SINGLETON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3004 W STRAWBERRY LN
HAYDEN ID
83835-8492
US

IV. Provider business mailing address

3004 W STRAWBERRY LN
HAYDEN ID
83835-8492
US

V. Phone/Fax

Practice location:
  • Phone: 850-776-7431
  • Fax:
Mailing address:
  • Phone: 850-776-7431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number9781818
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: