Marissa Ann Walters, PMD

Primary specialty

Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X

License

539885 Issued in FL

Practice address

1229 Atlantic Ave
Fruitland Park, FL 34731-3245

Phone

(352) 350-3801

NPI assigned

Aug 18, 2026

Last updated

Aug 18, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1787011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787011200000",
    "number": "1417862038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1229 ATLANTIC AVE",
            "city": "FRUITLAND PARK",
            "state": "FL",
            "postal_code": "347313245",
            "telephone_number": "352-350-3801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1229 ATLANTIC AVE",
            "city": "FRUITLAND PARK",
            "state": "FL",
            "postal_code": "347313245",
            "telephone_number": "352-350-3801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "MARISSA",
        "middle_name": "ANN",
        "credential": "PMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-08-18",
        "last_updated": "2026-08-18",
        "certification_date": "2026-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "FL",
            "license": "539885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Emergency Medical Services (Emergency Medicine) Physician in Fruitland Park, FL
• Providers in Fruitland Park, FL by specialty
• Emergency Medical Services (Emergency Medicine) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.