Provider Demographics
NPI:1538679774
Name:TASKOVSKA, MARINA
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:TASKOVSKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8335 38TH STREET CIR E UNIT 305
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-3663
Mailing Address - Country:US
Mailing Address - Phone:219-577-6619
Mailing Address - Fax:
Practice Address - Street 1:8335 38TH STREET CIR E UNIT 305
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-3663
Practice Address - Country:US
Practice Address - Phone:219-577-6619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9460058363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily