1720953391 NPI number — MADELYN LEIGH PARKER DNP, APRN, FNP-BC

Table of content: MADELYN LEIGH PARKER DNP, APRN, FNP-BC (NPI 1720953391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720953391 NPI number — MADELYN LEIGH PARKER DNP, APRN, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARKER
Provider First Name:
MADELYN
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DNP, APRN, FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720953391
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 20800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-4105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-402-7256
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
370 SE VERANDA FALLS WAY, STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT SAINT LUCIE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34984
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-763-1720
Provider Business Practice Location Address Fax Number:
772-214-3027
Provider Enumeration Date:
10/06/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  APRN11042794 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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