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General NPI Number Information
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NPI Number | 1497758338
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Entity Type | Individual
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Provider Name | MARILYN L JURICIC MD
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Gender | Female
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 03/08/2023
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Provider Practice Location Address
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Address Line | 1400 N US HIGHWAY 441 STE 912
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City | LADY LAKE
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State | FL
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Zip | 32159-6811
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Country | US
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Telephone | 352-750-1277
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Fax | 844-388-6186
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Provider Business Mailing Address
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Address Line | 601 S HARBOUR ISLAND BLVD STE 200
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City | TAMPA
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State | FL
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Zip | 33602-5925
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Country | US
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Telephone | 800-480-5243
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Fax | 800-928-7449
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME 71383
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License Number State | FL
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