Healthcare Provider Details

I. General information

NPI: 1083736193
Provider Name (Legal Business Name): JENNIFER JOY MARLIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER JOY BROWN PA-C

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 KEEWAHDIN RD
FORT GRATIOT MI
48059-3526
US

IV. Provider business mailing address

43151 DALCOMA DR SUITE 5
CLINTON TOWNSHIP MI
48038-6306
US

V. Phone/Fax

Practice location:
  • Phone: 810-455-1600
  • Fax: 810-455-1620
Mailing address:
  • Phone: 586-286-8720
  • Fax: 866-790-6803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: