Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OS13399 | FL |
N | 207QA0401X | Family Doctor - Addiction Medicine | OS13399 | FL |
N | 208D00000X | General Practice Physician | UO3299 | FL |
NPI | 1861748717 |
---|---|
Provider Name | Dr. Vicky Jasmine Marsh |
First Address | Plantation, FL 33317-2840 |
Second Address | Plantation, FL 33317-2850 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2012 |
Last Update Date | 06/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OS13399 | FL LICENSE (01) | FL |
UO3299 | TRADITIONAL ROTATING INTERN (01) | FL |