Provider Demographics
NPI:1053808675
Name:MARSHALL, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 KNIGHT ST
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-3928
Mailing Address - Country:US
Mailing Address - Phone:813-486-4529
Mailing Address - Fax:813-354-4541
Practice Address - Street 1:903 KNIGHT ST
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-3928
Practice Address - Country:US
Practice Address - Phone:813-486-4529
Practice Address - Fax:813-354-4541
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3747P1801X3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant