Healthcare Provider Details

I. General information

NPI: 1417869934
Provider Name (Legal Business Name): MARINA MAKHALY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 MEDICAL PARK
SMYRNA TN
37167-3599
US

IV. Provider business mailing address

3546 LAFAVE LN
MURFREESBORO TN
37129-0636
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
Mailing address:
  • Phone: 347-741-1690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF09260283
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: