Basic Information
| Provider Information | |||||||||
| NPI: | 1215932835 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHENCK | ||||||||
| FirstName: | MARLA | ||||||||
| MiddleName: | CRIST | ||||||||
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| Credential: | A.R.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4200 N ARMENIA AVE | ||||||||
| Address2: | STE 1 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336076438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138774811 | ||||||||
| FaxNumber: | 8138728978 | ||||||||
| Practice Location | |||||||||
| Address1: | 4915 EHRLICH RD | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336242038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139602400 | ||||||||
| FaxNumber: | 8139602410 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2005 | ||||||||
| LastUpdateDate: | 03/12/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP3178552 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 305983900 | 05 | FL | MEDICAID | 1411796 | 01 | FL | COVENTRY | OTHER | 9599505 | 01 | FL | AETNA | OTHER | 285850 | 01 | FL | AVMED | OTHER | P01161607 | 01 | RAILROAD MEDICARE | OTHER |