Provider Demographics
NPI:1336132554
Name:MARRA, ANN LAUREN (DC, CIME)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:LAUREN
Last Name:MARRA
Suffix:
Gender:F
Credentials:DC, CIME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12082 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-7371
Mailing Address - Country:US
Mailing Address - Phone:352-684-2707
Mailing Address - Fax:352-688-1282
Practice Address - Street 1:12082 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-7371
Practice Address - Country:US
Practice Address - Phone:352-684-2707
Practice Address - Fax:352-688-1282
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLH6649111N00000X
NJINACTIVE STATUS111N00000X
AL1509111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8155OtherMEDICARE PTAN
FLK8155OtherMEDICARE PTAN