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General NPI Number Information
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NPI Number | 1497153274
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Entity Type | Individual
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Provider Name | MARILYN STATON
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Gender | Female
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Dates
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Enumeration Date | 12/10/2014
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 53 DOUGLAS ST APT 34
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City | HOMOSASSA
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State | FL
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Zip | 34446-3958
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Country | US
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Telephone | 989-400-7541
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Fax |
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Provider Business Mailing Address
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Address Line | 22 GOLFVIEW DR
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City | HOMOSASSA
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State | FL
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Zip | 34446-4219
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Country | US
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Telephone | 989-400-7541
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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 | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | FK0578229
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9108371
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License Number State | FL
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