Provider Demographics
NPI:1649329962
Name:RAYMUND MARDER, KAREN R (ARNP)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:R
Last Name:RAYMUND MARDER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6450 38TH AVE N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1645
Mailing Address - Country:US
Mailing Address - Phone:727-344-6060
Mailing Address - Fax:727-347-5586
Practice Address - Street 1:6450 38TH AVE N
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1645
Practice Address - Country:US
Practice Address - Phone:727-344-6060
Practice Address - Fax:727-347-5586
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1088842363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001645500Medicaid