Provider Demographics
NPI:1164656039
Name:CREECH-JOYCE, MARCIA D (FNP,BC)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:D
Last Name:CREECH-JOYCE
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 1:1423 NW 25TH PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-4854
Mailing Address - Country:US
Mailing Address - Phone:505-917-9663
Mailing Address - Fax:
Practice Address - Street 1:1423 NW 25TH PL
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33993-4854
Practice Address - Country:US
Practice Address - Phone:505-917-9663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR63178363LF0000X
FLARNP 9304578363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily