Female

Mrs. Marly Harlan PA-C, MPAS

Physician Assistant in Jacksonville, FL(View on Map)

Full Name

Mrs. Marly Harlan PA-C, MPAS

NPI Number

1417994799

NPI Type

Individual Provider

Gender

Female

Enumeration Date

06/02/2006

Specialties

(Taxonomies)

Code

363A00000X

Primary Taxonomy

Yes

Licenses

State

Florida
Iowa

License Number

PA9104139
001647

Contact
Information

Purpose

Mailing
Location

Address

4500 SAN PABLO RD S
4500 SAN PABLO RD S

City

Jacksonville
Jacksonville

State

FL
FL

Postal Code

32224-1865
32224-1865

Country

US
US

Telephone Number

(904) 953-2000
(904) 953-2000

Identifiers

Identifier

PA9104139
001647
AG592Z

Identifier State

FL
IA
FL

Identifier Issuer

STATE PA LICENSE
STATE PA MEDICAL LICENSE
MEDICARE

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 12/26/2007

Provider Address

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