Provider Demographics
NPI:1114980364
Name:WITZLEB, MARGARET LOUISE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:LOUISE
Last Name:WITZLEB
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 W. EAU GALLIE BLVD.
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935
Mailing Address - Country:US
Mailing Address - Phone:321-775-0477
Mailing Address - Fax:321-775-0476
Practice Address - Street 1:2351 W. EAU GALLIE BLVD.
Practice Address - Street 2:SUITE 5
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935
Practice Address - Country:US
Practice Address - Phone:321-775-0477
Practice Address - Fax:321-775-0476
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9164887363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3031560-00Medicaid
FL3031560-00Medicaid
FLU8098ZMedicare PIN