Provider Demographics
NPI:1336270685
Name:PARKER, MARIAH LEIGH (ARNP)
Entity type:Individual
Prefix:MS
First Name:MARIAH
Middle Name:LEIGH
Last Name:PARKER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARIAH
Other - Middle Name:LEIGH
Other - Last Name:HOLTERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1015 SE 17TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-3968
Mailing Address - Country:US
Mailing Address - Phone:352-351-3422
Mailing Address - Fax:
Practice Address - Street 1:1015 SE 17TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-3968
Practice Address - Country:US
Practice Address - Phone:352-351-3422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL20412255A2300X
FLARNP9326065363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0Q88OtherFLORIDA BLUE
FLIC623ZOtherMEDICARE PTAN