ANN LAUREN MARRA D.C., C.I.M.E., NPI 1336132554 — BROOKSVILLE (FL)

NPI 1336132554

14+ Years Experience Individual

ANN LAUREN MARRA D.C., C.I.M.E.

08/23/2005
PROVIDER ENUMERATION DATE
09/15/2015
LAST UPDATE DATE
1336132554
NPI NUMBER

About ANN LAUREN MARRA

Sole proprietor? Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor.

ANN LAUREN MARRA is a provider established in BROOKSVILLE, FL. The NPI number of ANN LAUREN MARRA is 1336132554 and was assigned on 08/23/2005. The practitioners primary taxonomy code is: 111N00000X with license number: H6649 FL .

Mailing address

  • City: BROOKSVILLE
  • State: FL
  • Postal code: 346137371
  • Phone: 3526842707
  • Fax: 3526881282
  • Address: 12082 CORTEZ BLVD

Primary Practice Address

  • Region : BROOKSVILLE, FL
  • NPI : 1336132554
  • Phone : 3526842707
  • Fax : 3526881282
  • Postalcode : 346137371
  • Address : 12082 CORTEZ BLVD

Additional identifiers

  • Identifier: K8155
  • Code / Type : 1 - other
  • Identifier state : FL
  • Identifier issuer: MEDICARE PTAN

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Provider taxonomy - Chiropractor

  • Taxonomy code: 111N00000X
  • License number: H6649
  • License state: FL

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.

Healthcare provider taxonomy #2 - Chiropractor

  • Taxonomy code: 111N00000X
  • License number: INACTIVE STATUS
  • License state: NJ

The taxonomy is not the primary taxonomy.

Taxonomy description: A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.

Contacts:

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  • ANN LAUREN MARRA D.C., C.I.M.E.
  • Address : 12082 CORTEZ BLVD
  • Region : BROOKSVILLE, FL
  • NPI : 1336132554
  • Phone : 3526842707
  • Fax : 3526881282
  • Postalcode : 346137371

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address12082 CORTEZ BLVD
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameBROOKSVILLE
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameFL
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code346137371
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number3526842707
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number3526881282
The fax number associated with the location address of the provider being identified.
NPI1336132554
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1111N00000X
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.
Provider Enumeration Date08/23/2005
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated09/15/2015
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)ANN LAUREN MARRA
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address12082 CORTEZ BLVD
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City NameBROOKSVILLE
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameFL
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code346137371
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number3526842707
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number3526881282
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Healthcare Provider Taxonomy Code #1111N00000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Chiropractor
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.
Provider License Number 1H6649
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1FL
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Healthcare Provider Taxonomy Code 2111N00000X
Healthcare Provider Taxonomy 2Chiropractor
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.
Provider License Number 2INACTIVE STATUS
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 2NJ
Healthcare Provider Primary Taxonomy Switch 2N
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Other Provider Identifier 1K8155
Other Provider Identifier #1
Other Provider Identifier Type 11
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 1FL
Other Provider Identifier State #1
Other Provider Identifier Issuer 1MEDICARE PTAN
Other Provider Identifier Issuer #1
Provider Gender CodeF
  • M - male
  • F - female
Is sole proprietorY
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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