Provider Demographics
NPI:1437585635
Name:ALEXANDER, MARRIAN (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:MARRIAN
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 TARVER DR
Mailing Address - Street 2:
Mailing Address - City:BLAKELY
Mailing Address - State:GA
Mailing Address - Zip Code:39823
Mailing Address - Country:US
Mailing Address - Phone:229-723-2391
Mailing Address - Fax:
Practice Address - Street 1:4455 SAM MITCHELL DR
Practice Address - Street 2:
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-3501
Practice Address - Country:US
Practice Address - Phone:850-773-6100
Practice Address - Fax:850-773-6551
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN179472363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily