Provider Demographics
NPI:1336196591
Name:MARZOUK, CAROLIN K (NP)
Entity Type:Individual
Prefix:
First Name:CAROLIN
Middle Name:K
Last Name:MARZOUK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 MIDDLEBURY ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528-2956
Mailing Address - Country:US
Mailing Address - Phone:574-534-3300
Mailing Address - Fax:574-534-5412
Practice Address - Street 1:213 MIDDLEBURY STREET
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46528
Practice Address - Country:US
Practice Address - Phone:574-534-3300
Practice Address - Fax:574-534-5412
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28200111A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily