Healthcare Provider Details

I. General information

NPI: 1023356656
Provider Name (Legal Business Name): JOANN ELIZABETH MARINKOVICH-DAVIDSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANN MARINKOVICH

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S LAKE PARK AVE SP402
HOBART IN
46342-6638
US

IV. Provider business mailing address

8558 BROADWAY
MERRILLVILLE IN
46410-7032
US

V. Phone/Fax

Practice location:
  • Phone: 219-945-4488
  • Fax: 219-947-6015
Mailing address:
  • Phone: 219-392-7084
  • Fax: 219-703-6854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71004356A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: