Provider Demographics
NPI:1841694221
Name:MARCIAL, EDDY (DNP,APRN,NP,PMHNP-BC)
Entity type:Individual
Prefix:
First Name:EDDY
Middle Name:
Last Name:MARCIAL
Suffix:
Gender:M
Credentials:DNP,APRN,NP,PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13205 SW 137TH AVE STE 224-225
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5331
Mailing Address - Country:US
Mailing Address - Phone:786-290-9192
Mailing Address - Fax:800-603-8893
Practice Address - Street 1:13205 SW 137 AVE SUITE 232-233
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186
Practice Address - Country:US
Practice Address - Phone:786-290-9192
Practice Address - Fax:786-364-1894
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP-9231287363LP0808X
FLAPRN9231287363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIC281Medicare PIN