Provider Demographics
NPI:1013193366
Name:MCCLURE, MARLA RENEE (CRNP)
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:RENEE
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MARLA
Other - Middle Name:RENEE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13450 PERDIDO KEY DR UNIT 10420
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-9732
Mailing Address - Country:US
Mailing Address - Phone:256-460-0247
Mailing Address - Fax:
Practice Address - Street 1:13700 PERDIDO KEY DR UNIT 223
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-7475
Practice Address - Country:US
Practice Address - Phone:850-798-0760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-101693363LF0000X
OKR0122813363LF0000X
TX1059230363LF0000X
FL11011118363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily