Provider Demographics
NPI:1699915900
Name:MARKS, JENICA B (NP)
Entity type:Individual
Prefix:MRS
First Name:JENICA
Middle Name:B
Last Name:MARKS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4235 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623
Mailing Address - Country:US
Mailing Address - Phone:419-473-3561
Mailing Address - Fax:517-265-8237
Practice Address - Street 1:6450 WEATHERFIELD CT STE 1A
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-9149
Practice Address - Country:US
Practice Address - Phone:419-360-9747
Practice Address - Fax:855-710-6621
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA13499NP363LF0000X
MI4704264728163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0088231Medicaid