Provider Demographics
NPI:1902406176
Name:MARSH, JEFFREY K (FNP)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:K
Last Name:MARSH
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5227 CROSSWINDS DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-8956
Mailing Address - Country:US
Mailing Address - Phone:530-521-4072
Mailing Address - Fax:
Practice Address - Street 1:6419 CAROLINA BEACH RD STE A
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-3672
Practice Address - Country:US
Practice Address - Phone:910-790-3660
Practice Address - Fax:910-790-9499
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC301156163W00000X
NC5014249363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse