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General NPI Number Information
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NPI Number | 1437890878
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Entity Type | Individual
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Provider Name | MARISSA EARLY
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Gender | Female
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Dates
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Enumeration Date | 04/06/2022
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Last Update Date | 07/08/2022
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Provider Practice Location Address
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Address Line | 450 S ORANGE AVE
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City | ORLANDO
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State | FL
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Zip | 32801-3383
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Country | US
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Telephone | 407-930-9551
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Fax | 407-871-9240
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Provider Business Mailing Address
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Address Line | 5510 RAINTREE TRL
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City | FORT PIERCE
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State | FL
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Zip | 34982-3821
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Country | US
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Telephone | 619-997-6053
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 9774719
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | FB9774719
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 9774719
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 9774719
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | FB9774719
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License Number State | FL
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