Provider Demographics
NPI:1093400889
Name:GREENE, MARLISA ASHAUNTI
Entity Type:Individual
Prefix:
First Name:MARLISA
Middle Name:ASHAUNTI
Last Name:GREENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5210 PLUNKETT ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-8023
Mailing Address - Country:US
Mailing Address - Phone:754-465-3334
Mailing Address - Fax:
Practice Address - Street 1:5210 PLUNKETT ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8023
Practice Address - Country:US
Practice Address - Phone:754-465-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL202303056374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula