Basic Information
| Provider Information | |||||||||
| NPI: | 1235586231 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRECKEN-MARQUIS | ||||||||
| FirstName: | VERA | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4881 NW 8TH AVE | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326054582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3524161082 | ||||||||
| FaxNumber: | 3523736144 | ||||||||
| Practice Location | |||||||||
| Address1: | 1315 NW 21ST AVE | ||||||||
| Address2: | |||||||||
| City: | CHIEFLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326261978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3524905100 | ||||||||
| FaxNumber: | 3524905103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2016 | ||||||||
| LastUpdateDate: | 03/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP9256439 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | ARNP9256439 | 01 | FL | BOARD OF HEALTH | OTHER | RN9256439 | 01 | FL | FLORIDA BOARD OF HEALTH | OTHER | 018470300 | 05 | FL | MEDICAID |