Provider Demographics
NPI:1225755762
Name:FAUSTIN, MARILYNE R (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MARILYNE
Middle Name:R
Last Name:FAUSTIN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3947 SALISBURY RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6115
Mailing Address - Country:US
Mailing Address - Phone:904-252-7341
Mailing Address - Fax:
Practice Address - Street 1:3947 SALISBURY RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6115
Practice Address - Country:US
Practice Address - Phone:904-296-3533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2022-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL110227072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11022707OtherFLORIDA BOARD OF NURSING