Provider Demographics
NPI:1093897878
Name:MARVIN, PATRICIA (PA-CMPH)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MARVIN
Suffix:
Gender:F
Credentials:PA-CMPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 N SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32112-2109
Mailing Address - Country:US
Mailing Address - Phone:386-698-1088
Mailing Address - Fax:
Practice Address - Street 1:899 N SUMMIT ST
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:FL
Practice Address - Zip Code:32112-2109
Practice Address - Country:US
Practice Address - Phone:386-698-1088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102582363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical