Provider Demographics
NPI:1023356656
Name:MARINKOVICH-DAVIDSON, JOANN ELIZABETH (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:ELIZABETH
Last Name:MARINKOVICH-DAVIDSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JOANN
Other - Middle Name:
Other - Last Name:MARINKOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8558 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7032
Mailing Address - Country:US
Mailing Address - Phone:219-392-7084
Mailing Address - Fax:219-703-6854
Practice Address - Street 1:1500 S LAKE PARK AVE SP402
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-6638
Practice Address - Country:US
Practice Address - Phone:219-945-4488
Practice Address - Fax:219-947-6015
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004356A363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201140590Medicaid