Provider Demographics
NPI:1912039637
Name:BOATRIGHT, MARLA
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:
Last Name:BOATRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2551 RANCHSIDE TER
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-3638
Mailing Address - Country:US
Mailing Address - Phone:727-808-7515
Mailing Address - Fax:
Practice Address - Street 1:2551 RANCHSIDE TER
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-3638
Practice Address - Country:US
Practice Address - Phone:727-808-7515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5176499164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse