Healthcare Provider Details

I. General information

NPI: 1376477505
Provider Name (Legal Business Name): CORI MARZONI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 98 PLACE BLVD
HATTIESBURG MS
39402-8603
US

IV. Provider business mailing address

56 98 PLACE BLVD
HATTIESBURG MS
39402-8603
US

V. Phone/Fax

Practice location:
  • Phone: 601-264-7286
  • Fax: 601-450-4640
Mailing address:
  • Phone: 601-264-7286
  • Fax: 601-450-4640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number899038
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number899038
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number899038
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: