Provider Demographics
NPI:1467495119
Name:MARLIN, MARSHA L (CRNA)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:L
Last Name:MARLIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MARSHA
Other - Middle Name:L
Other - Last Name:JARRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 299
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37349-0299
Mailing Address - Country:US
Mailing Address - Phone:931-728-5607
Mailing Address - Fax:931-728-8354
Practice Address - Street 1:481 INTERSTATE DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-3108
Practice Address - Country:US
Practice Address - Phone:931-728-5607
Practice Address - Fax:931-728-8354
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9292367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4049106OtherBLUECROSS
TN3608238Medicaid
TN3608234Medicaid
TN430077095OtherRAILROAD MEDICARE
TN3608234Medicare ID - Type UnspecifiedTIN 621142980
TN3608233Medicare ID - Type Unspecified