Provider Demographics
NPI:1881575876
Name:MARRA, JUDITH (LPN,RN)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:MARRA
Suffix:
Gender:F
Credentials:LPN,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 BELMONT PL
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-7843
Mailing Address - Country:US
Mailing Address - Phone:512-921-4464
Mailing Address - Fax:
Practice Address - Street 1:1609 BELMONT PL
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-7843
Practice Address - Country:US
Practice Address - Phone:512-921-4464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192173-01163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency