Provider Demographics
NPI:1679110316
Name:MATHENY, MARJORIE (FNP-C)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:MATHENY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3241 HIDDEN MEADOWS CT
Mailing Address - Street 2:
Mailing Address - City:GREEN CV SPGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-7051
Mailing Address - Country:US
Mailing Address - Phone:904-616-6021
Mailing Address - Fax:
Practice Address - Street 1:7011 A C SKINNER PKWY STE 160
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6953
Practice Address - Country:US
Practice Address - Phone:904-493-3333
Practice Address - Fax:904-493-2222
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11002222363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner