Provider Demographics
NPI:1619073921
Name:HORKINS, MARCIE ANNE
Entity Type:Individual
Prefix:
First Name:MARCIE
Middle Name:ANNE
Last Name:HORKINS
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 1:6830 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-1410
Mailing Address - Country:US
Mailing Address - Phone:772-873-6700
Mailing Address - Fax:772-465-5499
Practice Address - Street 1:2 COLUMBIA DR
Practice Address - Street 2:SUITE A 327
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3508
Practice Address - Country:US
Practice Address - Phone:813-844-4396
Practice Address - Fax:813-844-4972
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9268019367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308913400Medicaid
AZ34488805Medicaid
FLG4437OtherBCBS
AZZ60823Medicare PIN
FL308913400Medicaid