Provider Demographics
NPI:1659465755
Name:SUMMERS, MARLENE M (CNM)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:M
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6400 W NEWBERRY RD
Mailing Address - Street 2:STE 207
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-6600
Mailing Address - Country:US
Mailing Address - Phone:352-371-2011
Mailing Address - Fax:352-384-3611
Practice Address - Street 1:449 SE BAYA DRIVE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025
Practice Address - Country:US
Practice Address - Phone:386-755-0500
Practice Address - Fax:386-755-9217
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL1370482363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL240386OtherAVMED
FLY9008OtherBCBS PROVIDER NUMBER
FL340059000Medicaid
FLY9008OtherBCBS PROVIDER NUMBER
FL240386OtherAVMED