Provider Demographics
NPI:1043957475
Name:MARRA, JAMES EDWARD (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:MARRA
Suffix:
Gender:M
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 W 1ST ST APT 702
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-2328
Mailing Address - Country:US
Mailing Address - Phone:239-898-9470
Mailing Address - Fax:
Practice Address - Street 1:11595 BURNT MILL RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-3096
Practice Address - Country:US
Practice Address - Phone:904-596-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11019704363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner