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General NPI Number Information
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NPI Number | 1679661326
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Entity Type | Individual
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Provider Name | MARLENE IRENE GARANCOSKY NP
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Gender | Female
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 12/21/2010
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Provider Practice Location Address
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Address Line | 10442 SCOTT MILL RD
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City | JACKSONVILLE
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State | FL
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Zip | 32257-6228
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Country | US
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Telephone | 904-465-3004
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Fax |
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Provider Business Mailing Address
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Address Line | 10442 SCOTT MILL RD
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City | JACKSONVILLE
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State | FL
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Zip | 32257-6228
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Country | US
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Telephone | 904-465-3004
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP1613692
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License Number State | FL
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