Provider Demographics
NPI:1972934222
Name:MARKS, MELISSA-MARIE (LM)
Entity Type:Individual
Prefix:MS
First Name:MELISSA-MARIE
Middle Name:
Last Name:MARKS
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 WASHINGTON AVE APT 23
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34450-4972
Mailing Address - Country:US
Mailing Address - Phone:352-651-4227
Mailing Address - Fax:
Practice Address - Street 1:311 WASHINGTON AVE APT 23
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34450-4972
Practice Address - Country:US
Practice Address - Phone:352-651-4227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-11
Last Update Date:2020-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW 285176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010362300Medicaid