Provider Demographics
NPI:1760452940
Name:KING, MARCIA E (APRN)
Entity Type:Individual
Prefix:MISS
First Name:MARCIA
Middle Name:E
Last Name:KING
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:MARCIA
Other - Middle Name:E
Other - Last Name:KING-AHMAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1051 PORT MALABAR BLVD NE STE 6
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-5156
Mailing Address - Country:US
Mailing Address - Phone:321-727-9063
Mailing Address - Fax:321-728-1955
Practice Address - Street 1:1051 PORT MALABAR BLVD NE STE 6
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-5156
Practice Address - Country:US
Practice Address - Phone:321-727-9063
Practice Address - Fax:321-728-1955
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2838142363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4006WMedicare UPIN
FLP05024Medicare UPIN