Provider Demographics
NPI:1073163192
Name:MARVILLE, JAMIE NICOLE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:NICOLE
Last Name:MARVILLE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2726 WINDGUARD CIR STE 102
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-7361
Mailing Address - Country:US
Mailing Address - Phone:813-999-0505
Mailing Address - Fax:813-701-9450
Practice Address - Street 1:2726 WINDGUARD CIR STE 102
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-7361
Practice Address - Country:US
Practice Address - Phone:813-999-0505
Practice Address - Fax:813-701-9450
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004169207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine