Provider Demographics
NPI:1730787441
Name:MARSHALL, JAIME SCOTT (CRNA, APRN)
Entity type:Individual
Prefix:MR
First Name:JAIME
Middle Name:SCOTT
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:CRNA, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1843 SOMMARIE WAY
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-6206
Mailing Address - Country:US
Mailing Address - Phone:843-812-7641
Mailing Address - Fax:
Practice Address - Street 1:1843 SOMMARIE WAY
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-6206
Practice Address - Country:US
Practice Address - Phone:843-812-7641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FL11010647367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program