Provider Demographics
NPI:1164283297
Name:NETTLES, MARQUITA PETERS (PMHNP)
Entity Type:Individual
Prefix:
First Name:MARQUITA
Middle Name:PETERS
Last Name:NETTLES
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:MARQUITA
Other - Middle Name:SHAWDA ARLETTE
Other - Last Name:NETTLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3209 MIDTOWN PARK S
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-4126
Mailing Address - Country:US
Mailing Address - Phone:251-525-9090
Mailing Address - Fax:251-525-9091
Practice Address - Street 1:3209 MIDTOWN PARK S
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-4126
Practice Address - Country:US
Practice Address - Phone:251-525-9090
Practice Address - Fax:251-525-9091
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-158198363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner