Provider Demographics
NPI:1417546177
Name:JURISIC, MARISA DIAMOND (MSN, NP-C)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:DIAMOND
Last Name:JURISIC
Suffix:
Gender:F
Credentials:MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 HAND AVE
Mailing Address - Street 2:
Mailing Address - City:BAY MINETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36507-4110
Mailing Address - Country:US
Mailing Address - Phone:251-937-5521
Mailing Address - Fax:
Practice Address - Street 1:1815 HAND AVE
Practice Address - Street 2:
Practice Address - City:BAY MINETTE
Practice Address - State:AL
Practice Address - Zip Code:36507-4110
Practice Address - Country:US
Practice Address - Phone:251-435-1330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-15
Last Update Date:2022-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-154589363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily