Provider Demographics
NPI:1346426764
Name:MASSEY, MARANDA NICOLE (APRN, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:MARANDA
Middle Name:NICOLE
Last Name:MASSEY
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:MARANDA
Other - Middle Name:NICOLE
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2389 COUNTRY SIDE DR
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4907
Mailing Address - Country:US
Mailing Address - Phone:850-603-0771
Mailing Address - Fax:
Practice Address - Street 1:6488 103RD ST STE A
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-7161
Practice Address - Country:US
Practice Address - Phone:904-450-6815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9218621163WS0200X
FL11020330363LF0000X
FL9218621163WE0003X, 163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WS0200XNursing Service ProvidersRegistered NurseSchool
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily