Provider Demographics
NPI:1861720948
Name:MARDEN, IVAN SCOTT (RN)
Entity type:Individual
Prefix:MR
First Name:IVAN
Middle Name:SCOTT
Last Name:MARDEN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19030 NW 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:REDDICK
Mailing Address - State:FL
Mailing Address - Zip Code:32686-2312
Mailing Address - Country:US
Mailing Address - Phone:352-262-2999
Mailing Address - Fax:
Practice Address - Street 1:19030 NW 60TH AVE
Practice Address - Street 2:
Practice Address - City:REDDICK
Practice Address - State:FL
Practice Address - Zip Code:32686-2312
Practice Address - Country:US
Practice Address - Phone:352-262-2999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1240652163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator