Provider Demographics
NPI:1265970149
Name:MARRKAND, JACLYN CHRISTINE (CRNA)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:CHRISTINE
Last Name:MARRKAND
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:CHRISTINE
Other - Last Name:ASHLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1205 HADLEY PARK LN
Mailing Address - Street 2:
Mailing Address - City:WEDDINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28104-8066
Mailing Address - Country:US
Mailing Address - Phone:610-704-3413
Mailing Address - Fax:
Practice Address - Street 1:1000 BLYTHE BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5812
Practice Address - Country:US
Practice Address - Phone:610-704-3413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-10
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC329108163W00000X, 367500000X
NC6516367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse