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Individual

MICHAEL BRADLEY MARKS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
FNP

Contact information

Practice address
3280A HENDERSON DR, JACKSONVILLE, NC 28546-5250
(910) 937-7200
(910) 937-7061
Mailing address
PO BOX 602373, CHARLOTTE, NC 28260-2373

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
201201
NC
363L00000X
Nurse Practitioner
Primary
3012624
KY
363LF0000X
Family Nurse Practitioner
201201
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7000339
NC
Enumeration date
03/14/2006
Last updated
03/20/2019
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