Marita Joan Prince, DNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

241332 Issued in AZ

Practice address

36065 Santa Fe Ave
Fort Hood, TX 76544-5060

Phone

(301) 295-9004

NPI assigned

Nov 16, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1132099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1649252438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4313 FAIRWAY PATH",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786651455",
            "telephone_number": "573-855-2576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36065 SANTA FE AVE",
            "city": "FORT HOOD",
            "state": "TX",
            "postal_code": "765445060",
            "telephone_number": "301-295-9004"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18th MEDCOM",
            "address_purpose": "LOCATION",
            "city": "APO",
            "state": "AP",
            "postal_code": "962050054",
            "country_code": "KR",
            "telephone_number": "01182279166027",
            "fax_number": "01182279178110",
            "country_name": "Korea, Republic of",
            "address_type": "FGN"
        }
    ],
    "basic": {
        "last_name": "PRINCE",
        "first_name": "MARITA",
        "middle_name": "JOAN",
        "name_prefix": "Mrs.",
        "credential": "DNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-11-16",
        "last_updated": "2022-07-21",
        "certification_date": "2020-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AZ",
            "license": "RN132098",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "AZ",
            "license": "RN132098",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "241332",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles Joseph Poth III, R.PH.
• Angela M Powell Lewis, RN, MSN, CCM
• Patricia Ann Pratt, RN ARNP
• Cearra Teressa Marie Prejean, APRN FNP-C
• Brady Price, RN
• Kristi Michal Ensor Pruiksma, PHD
• Debra L Pugh, RN
• William Burks Purcell, O.D.
• Nancy Anne Radebaugh, PHARMD
• Terry Earl Raines, CRNA

• Family Nurse Practitioner in Fort Hood, TX
• Providers in Fort Hood, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.