Healthcare Provider Details

I. General information

NPI: 1649339144
Provider Name (Legal Business Name): PAULA NICOLE MARRIOTT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10504 SUTPHIN BLVD
JAMAICA NY
11435-5022
US

IV. Provider business mailing address

466 BEACH 64TH ST
ARVERNE NY
11692-1423
US

V. Phone/Fax

Practice location:
  • Phone: 718-725-5000
  • Fax: 718-725-5804
Mailing address:
  • Phone: 718-318-0897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number283322-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN5161567
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number616852
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number616852
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: