Provider Demographics
NPI:1588114458
Name:DAUGHERTY, MARILYN (ARNP)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:DAUGHERTY
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 1:2902 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-6009
Mailing Address - Country:US
Mailing Address - Phone:407-957-0090
Mailing Address - Fax:407-957-1113
Practice Address - Street 1:2902 17TH STREET
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-7064
Practice Address - Country:US
Practice Address - Phone:407-957-0090
Practice Address - Fax:407-957-1113
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9303439363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner