Provider Demographics
NPI:1225330194
Name:MATHURIN, MARIE (NP)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:MATHURIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5454 LEE ST # 2
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-4921
Mailing Address - Country:US
Mailing Address - Phone:617-699-4542
Mailing Address - Fax:
Practice Address - Street 1:5454 LEE ST # 2
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4921
Practice Address - Country:US
Practice Address - Phone:617-699-4542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2024-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11016830363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology