Provider Demographics
NPI:1306825625
Name:HERRMANN, MARIE MORLEY (GNP)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:MORLEY
Last Name:HERRMANN
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LADY LN
Mailing Address - Street 2:
Mailing Address - City:FALL BRANCH
Mailing Address - State:TN
Mailing Address - Zip Code:37656-1814
Mailing Address - Country:US
Mailing Address - Phone:561-301-5667
Mailing Address - Fax:
Practice Address - Street 1:300 LADY LN
Practice Address - Street 2:
Practice Address - City:FALL BRANCH
Practice Address - State:TN
Practice Address - Zip Code:37656-1814
Practice Address - Country:US
Practice Address - Phone:561-301-5667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2944262363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ42147Medicare UPIN