Provider Demographics
NPI:1831543024
Name:DODD-O, MARLESA ANNE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MARLESA
Middle Name:ANNE
Last Name:DODD-O
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 MEMORIAL MEDICAL PKWY STE 206
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5169
Mailing Address - Country:US
Mailing Address - Phone:386-231-4450
Mailing Address - Fax:386-231-4459
Practice Address - Street 1:305 MEMORIAL MEDICAL PKWY STE 206
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5169
Practice Address - Country:US
Practice Address - Phone:386-231-4450
Practice Address - Fax:386-231-4459
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHPA1160363A00000X
MAPA5633363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant