Healthcare Provider Details

I. General information

NPI: 1376992313
Provider Name (Legal Business Name): FREDRICKA MARSH DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 BREN RD E, MAIL ROUTE MN 008-B213
MINNETONKA MN
55343-9664
US

IV. Provider business mailing address

2111 SW 35TH AVE
FORT LAUDERDALE FL
33312-3627
US

V. Phone/Fax

Practice location:
  • Phone: 954-299-2498
  • Fax:
Mailing address:
  • Phone: 954-257-2601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9184714
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: