Provider Demographics
NPI:1538229646
Name:MARKS, HELENE (ARNP)
Entity type:Individual
Prefix:
First Name:HELENE
Middle Name:
Last Name:MARKS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:HELEN
Other - Middle Name:
Other - Last Name:DECOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:120 HEALTH PARK BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5798
Mailing Address - Country:US
Mailing Address - Phone:904-823-3401
Mailing Address - Fax:904-829-8649
Practice Address - Street 1:120 HEALTH PARK BLVD
Practice Address - Street 2:STE 1
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086
Practice Address - Country:US
Practice Address - Phone:904-823-3401
Practice Address - Fax:904-829-8649
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158284363LF0000X
FLARNP9451351363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0712582Medicaid
MANP4537Medicare PIN
MAUX9635Medicare PIN
MA0712582Medicaid