Provider Demographics
NPI:1568172575
Name:BATES, MARCIA S (ARNP)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:S
Last Name:BATES
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 1:11632 CAMBIUM CROWN DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-5720
Mailing Address - Country:US
Mailing Address - Phone:813-404-2362
Mailing Address - Fax:
Practice Address - Street 1:11632 CAMBIUM CROWN DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-5720
Practice Address - Country:US
Practice Address - Phone:813-404-2362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023244363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily