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Individual
MRS. MARLY HARLAN
Active
Individual
MRS. MARLY HARLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, MPAS
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
001647
IA
363A00000X
Physician Assistant
Primary
PA9104139
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001647
STATE PA MEDICAL LICENSE
IA
01
—
AG592Z
MEDICARE
FL
01
—
PA9104139
STATE PA LICENSE
FL
Enumeration date
06/02/2006
Last updated
12/26/2007
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