Provider Demographics
NPI:1992211783
Name:MARKS, PHILIP (FNP-C)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:MARKS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11111 SALT LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-2430
Mailing Address - Country:US
Mailing Address - Phone:858-337-5278
Mailing Address - Fax:
Practice Address - Street 1:11111 SALT LAKE AVE
Practice Address - Street 2:
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-2430
Practice Address - Country:US
Practice Address - Phone:858-337-5278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-16
Last Update Date:2017-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007804363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily