Provider Demographics
NPI:1285779629
Name:NORRIS, MARIE A (ARNP)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:A
Last Name:NORRIS
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 1:5120 NW 149TH TER
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-7710
Mailing Address - Country:US
Mailing Address - Phone:352-332-7177
Mailing Address - Fax:
Practice Address - Street 1:717 SW 4TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-6457
Practice Address - Country:US
Practice Address - Phone:352-378-2882
Practice Address - Fax:352-377-8250
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0978622367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY7280OtherBLUE CROSS BLUE SHIELD