MEDICARE: ELIZABETH KEELER MARSHALL PA-C

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA9106747	FL
2	363A00000X	Physician Assistant	PA9106747	FL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LK444	OTHER	FL	MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	Y0QS5	OTHER	FL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1710237276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH KEELER MARSHALL PA-C

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE STE 200
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9328
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:

Provider Business Practice Location Address
First Line	:	1132 S 14TH ST
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-2920
Country	:	US
Telephone Number	:	904-277-4690
Fax Number	:	904-277-8487

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

Provider Enumeration Date	:	09/12/2012
Last Update Date	:	03/02/2026

1132 S 14TH ST
FERNANDINA BEACH, FL
32034-2920

Practice Phone: 904-277-4690
Practice Fax: 904-277-8487

1126 S 14TH ST
FERNANDINA BEACH, FL
32034-2920