Healthcare Provider Details

I. General information

NPI: 1508366485
Provider Name (Legal Business Name): MARCY ANTOINETTE FITZGERALD APRN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARCY ANTOINETTE DAVIS

II. Dates (important events)

Enumeration Date: 02/16/2018
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 COMPTON RD
CINCINNATI OH
45231
US

IV. Provider business mailing address

PO BOX 43543
CINCINNATI OH
45243-0543
US

V. Phone/Fax

Practice location:
  • Phone: 513-522-7500
  • Fax:
Mailing address:
  • Phone: 513-376-3493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number15698
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.15698
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: