=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184513087
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAEGAN MARSH APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2025
-----------------------------------------------------
Last Update Date | 07/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 PHILLIPS RD
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32308-5304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-878-4127
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 TOM WHITE LN
-----------------------------------------------------
City | CRAWFORDVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32327-4057
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-949-6012
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | APRN11040615
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------