Theresa Marin, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

247988 Issued in AZ

Practice address

1611 E Joy LN
Fort Mohave, AZ 86426-8807

Phone

(928) 788-8000

NPI assigned

Oct 14, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• West Coast Wound and Skin Care Inc

  • Surgery Physician
  • Burbank, CA
  • NPI 1437675980

  AZ

  Medicare reassignment NPD
• Colorado River Pediatrics, LLC

  • Pediatrics Physician
  • Fort Mohave, AZ
  • NPI 1235410077
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602633600000",
    "number": "1174121883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3469 SUNGLOW DR",
            "city": "BULLHEAD CITY",
            "state": "AZ",
            "postal_code": "864297623",
            "telephone_number": "702-420-5048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 E JOY LN",
            "city": "FORT MOHAVE",
            "state": "AZ",
            "postal_code": "864268807",
            "telephone_number": "928-788-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARIN",
        "first_name": "THERESA",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-14",
        "last_updated": "2020-10-14",
        "certification_date": "2020-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "247988",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth Dudley Locke, DO
• Loyal Hospice & Palliative Care, LLC (Serenity Home Health)
• Loyal Hospice & Palliative Care, LLC (Serenity Hospice)
• Kristine Luna, NP
• Khushwant Singh Mangat, MD
• Carlos A Martinez
• Cliffard D Mayo, MBA, MS, LAC
• Medicorp, Inc.
• Medstat Anesthesia Consultants
• Francisco J. Melo, MD

• Family Nurse Practitioner in Fort Mohave, AZ
• Providers in Fort Mohave, AZ by specialty
• Family Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.