Provider Demographics
NPI:1821555079
Name:MYRICK, MARIE (APRN PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:MYRICK
Suffix:
Gender:F
Credentials:APRN PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 MICCOSUKEE COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5432
Mailing Address - Country:US
Mailing Address - Phone:850-765-8120
Mailing Address - Fax:
Practice Address - Street 1:1820 MICCOSUKEE CMNS
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5432
Practice Address - Country:US
Practice Address - Phone:850-765-8120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN110295142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry