MEDICARE: TYVONNA MARLIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1124904594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYVONNA MARLIN

Provider Business Mailing Address
First Line	:	688 MAPLE AVE
Second Line	:
City	:	ELIZABETH
State	:	NJ
Zip	:	07202-2624
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	688 MAPLE AVE
Second Line	:
City	:	ELIZABETH
State	:	NJ
Zip	:	07202-2624
Country	:	US
Telephone Number	:	551-404-0819
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2025
Last Update Date	:	08/12/2025

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Directions to “ TYVONNA MARLIN ” Practice Location

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