Provider Demographics
NPI:1033346747
Name:MARRERO, ISLA STARR (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:ISLA STARR
Middle Name:
Last Name:MARRERO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5702
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31107-0702
Mailing Address - Country:US
Mailing Address - Phone:716-830-4456
Mailing Address - Fax:
Practice Address - Street 1:3075 BRECKINRIDGE BLVD
Practice Address - Street 2:SUITE 415
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-7612
Practice Address - Country:US
Practice Address - Phone:770-962-8396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-20
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY420933363LW0102X
GA171405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health