Provider Demographics
NPI:1164886123
Name:WEBER, MARIE M (NP, PMHNP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:M
Last Name:WEBER
Suffix:
Gender:F
Credentials:NP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3175 TOWER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-2548
Mailing Address - Country:US
Mailing Address - Phone:516-698-4194
Mailing Address - Fax:
Practice Address - Street 1:3175 TOWER OAKS DR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-2548
Practice Address - Country:US
Practice Address - Phone:516-698-4194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9274191363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily