Individual provider Active NPI

Jacqueline Marks, NP

  • Primary Care Nurse Practitioner
  • Canton, GA
National Provider Identifier
1942634175
Registry record updated Jul 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
RN163623 Issued in GA
Practice address
450 Northside Cherokee Blvd
Canton, GA 30115-8015
Phone
(770) 224-1000
Fax
(770) 224-2451
NPI assigned
Aug 23, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X RN163623 GA Primary
Family Nurse Practitioner 363LF0000X AP124180 TX
Primary Care Nurse Practitioner 363LP2300X 840805 TX

Addresses

Primary practice location

450 Northside Cherokee Blvd
Canton, GA 30115-8015

Mailing address

7703 Floyd Curl Dr
Mc7977
San Antonio, TX 78229-3901
Phone (210) 358-4000

Other practice location 1

16755 Huebner Rd
San Antonio, TX 78248-2342
Phone (210) 493-4357

Other identifiers 2

IdentifierTypeStateIssuer
327389802MedicaidTX
327389803OtherTXCSHCN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20131104000532 TX Practitioner - Nurse Practitioner 0446485247 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
840805TXMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Vitas Health Services of Texas, P.a. CurrentSince Apr 8, 2019 Accepting new patients
Curana Health Medical Group LLC CurrentSince Jul 1, 2016 Accepting new patients

Locations

9903 Hunters Pond
San Antonio, TX 78224
Phone (210) 477-2200

8401 Datapoint Dr
Ste 300
San Antonio, TX 78229
Phone (210) 348-4040

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1377216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783382400000",
    "number": "1942634175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7703 FLOYD CURL DR",
            "address_2": "MC7977",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293901",
            "telephone_number": "210-358-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 NORTHSIDE CHEROKEE BLVD",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301158015",
            "telephone_number": "770-224-1000",
            "fax_number": "770-224-2451"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16755 Huebner Rd",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782482342",
            "country_code": "US",
            "telephone_number": "210-493-4357",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARKS",
        "first_name": "JACQUELINE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-23",
        "last_updated": "2026-07-07",
        "certification_date": "2026-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "GA",
            "license": "RN163623",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP124180",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "TX",
            "license": "840805",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "327389802",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CSHCN",
            "identifier": "327389803",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, GA

Sources for this page

Verify at the official NPI Registry.