Provider Demographics
NPI:1235627860
Name:KNIGHT, MARLENA OCTAVIA (ARNP)
Entity Type:Individual
Prefix:MR
First Name:MARLENA
Middle Name:OCTAVIA
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4237 S PIPKIN RD BLDG 1
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-1442
Mailing Address - Country:US
Mailing Address - Phone:863-701-2470
Mailing Address - Fax:863-701-2474
Practice Address - Street 1:4237 S PIPKIN RD BLDG 1
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33811-1442
Practice Address - Country:US
Practice Address - Phone:863-701-2470
Practice Address - Fax:863-701-2474
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9224536363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology