Provider Demographics
NPI:1669603197
Name:POUND, MARJORIE TEATE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:TEATE
Last Name:POUND
Suffix:
Gender:F
Credentials:ARNP
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Other - Credentials:
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP - PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3199
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:3122 NEW BERLIN RD
Practice Address - Street 2:UFJAX - DEPT. OF FAMILY MEDICINE
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32226-1828
Practice Address - Country:US
Practice Address - Phone:904-633-0340
Practice Address - Fax:904-633-0341
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP2887702363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0013209-00Medicaid
FLCI291YMedicare PIN
FLCI291XMedicare PIN
FL0013209-00Medicaid