MEDICARE: MRS. WHITNEY MARIE MAREMA RN

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	163WM0705X	Medical-Surgical Registered Nurse	3417842	FL
2	363LP2300X	Primary Care Nurse Practitioner	3417842	FL
3	363L00000X	Nurse Practitioner	APRN3417842	FL

General Provider Information

NPI Number	:	1659888683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WHITNEY MARIE MAREMA RN

Provider Business Mailing Address
First Line	:	300 HEALTH PARK BLVD STE 5002
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32086-3705
Country	:	US
Telephone Number	:	904-501-6203
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 HEALTH PARK BLVD STE 5002
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32086-3705
Country	:	US
Telephone Number	:	904-501-6203
Fax Number	:

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

Provider Enumeration Date	:	12/28/2017
Last Update Date	:	01/08/2020

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