Provider Demographics
NPI:1508063686
Name:BOUNDS, MARSHA ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:ANN
Last Name:BOUNDS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 E COLONIAL DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4912
Mailing Address - Country:US
Mailing Address - Phone:407-345-1551
Mailing Address - Fax:407-345-4893
Practice Address - Street 1:6200 METROWEST BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-7636
Practice Address - Country:US
Practice Address - Phone:407-345-1551
Practice Address - Fax:407-345-4893
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL860752363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1104864826OtherNPI GROUP SAND LAKE MEDICAL ASSOCIATES, P.A.
FLK0617OtherMEDICARE ELECTRONIC GROUP ID
FL1104864826OtherNPI GROUP SAND LAKE MEDICAL ASSOCIATES, P.A.
FLK0617OtherMEDICARE ELECTRONIC GROUP ID