Provider Demographics
NPI:1861748717
Name:MARSH, VICKY JASMINE (DO)
Entity type:Individual
Prefix:DR
First Name:VICKY
Middle Name:JASMINE
Last Name:MARSH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:VICKY
Other - Middle Name:
Other - Last Name:KOSAKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2300 NW 89TH PL FL 3
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2431
Mailing Address - Country:US
Mailing Address - Phone:305-398-6100
Mailing Address - Fax:
Practice Address - Street 1:4900 W OAKLAND PARK BLVD FL 3
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-7500
Practice Address - Country:US
Practice Address - Phone:954-327-4060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13399207Q00000X, 207QA0401X
FLUO3299208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS13399OtherFL LICENSE
FLUO3299OtherTRADITIONAL ROTATING INTERN
FL101182500Medicaid