Provider Demographics
NPI:1689997397
Name:MARLIN, JERRY L (ARNP)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:L
Last Name:MARLIN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 HARTMAN RD STE 1
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-4412
Mailing Address - Country:US
Mailing Address - Phone:772-465-1170
Mailing Address - Fax:772-465-1171
Practice Address - Street 1:2000 HARTMAN RD STE 1
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-4412
Practice Address - Country:US
Practice Address - Phone:772-465-1170
Practice Address - Fax:772-465-1171
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3274792363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner