Provider Demographics
NPI:1215932835
Name:SCHENCK, MARLA CRIST (ARNP)
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:CRIST
Last Name:SCHENCK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 N ARMENIA AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6438
Mailing Address - Country:US
Mailing Address - Phone:813-877-4811
Mailing Address - Fax:813-872-8978
Practice Address - Street 1:4915 EHRLICH RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-2038
Practice Address - Country:US
Practice Address - Phone:813-960-2400
Practice Address - Fax:813-960-2410
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3178552363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305983900Medicaid
FL1411796OtherCOVENTRY
FL9599505OtherAETNA
FL285850OtherAVMED
P01161607OtherRAILROAD MEDICARE
P01161607OtherRAILROAD MEDICARE