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General NPI Number Information
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NPI Number | 1750105995
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Entity Type | Individual
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Provider Name | MARC EDDY THEODOR PMHNP
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Gender | Male
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 02/04/2026
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Provider Practice Location Address
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Address Line | 2338 IMMOKALEE RD # 559
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City | NAPLES
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State | FL
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Zip | 34110-1445
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Country | US
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Telephone | 239-610-0194
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Fax |
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Provider Business Mailing Address
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Address Line | 2338 IMMOKALEE RD # 559
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City | NAPLES
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State | FL
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Zip | 34110-1445
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Country | US
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Telephone | 239-610-0194
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Fax | 239-282-4185
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11036065
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9555670
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License Number State | FL
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