Provider Demographics
NPI:1386071355
Name:MCTHAY, MARJORIE (FNP)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:MCTHAY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KINGS POINT DR
Mailing Address - Street 2:#1714
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4774
Mailing Address - Country:US
Mailing Address - Phone:954-668-1328
Mailing Address - Fax:
Practice Address - Street 1:100 KINGS POINT DR
Practice Address - Street 2:#1714
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-4774
Practice Address - Country:US
Practice Address - Phone:954-668-1328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-04
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9288472363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care