Provider Demographics
NPI:1225205396
Name:MARJAMA, KRISTEN (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:
Last Name:MARJAMA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11105 STIRLING RD
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-6316
Mailing Address - Country:US
Mailing Address - Phone:954-689-0637
Mailing Address - Fax:
Practice Address - Street 1:11105 STIRLING RD
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328-6316
Practice Address - Country:US
Practice Address - Phone:954-689-0637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3196702363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP75018Medicare UPIN
FLE7854YMedicare PIN