Provider Demographics
NPI:1528566437
Name:NICKELS, MARNIE (ARNP)
Entity Type:Individual
Prefix:
First Name:MARNIE
Middle Name:
Last Name:NICKELS
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 1:177 N US HIGHWAY 1 STE 101
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-2746
Mailing Address - Country:US
Mailing Address - Phone:561-203-1335
Mailing Address - Fax:
Practice Address - Street 1:3401 PGA BLVD STE 310
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2824
Practice Address - Country:US
Practice Address - Phone:561-203-1335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9233103363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily