Provider Demographics
NPI:1750037560
Name:MARPLE, DERRICK (MSN-FNP)
Entity type:Individual
Prefix:MR
First Name:DERRICK
Middle Name:
Last Name:MARPLE
Suffix:
Gender:M
Credentials:MSN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH VIENNA
Mailing Address - State:OH
Mailing Address - Zip Code:45369-9747
Mailing Address - Country:US
Mailing Address - Phone:937-605-9294
Mailing Address - Fax:
Practice Address - Street 1:1117 E HOME RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2725
Practice Address - Country:US
Practice Address - Phone:937-342-1619
Practice Address - Fax:937-390-7148
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0030729363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily