Provider Demographics
NPI:1073692349
Name:MARINO, JOANNE LOUISE (APRN)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:LOUISE
Last Name:MARINO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 PAPE RD
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-2124
Mailing Address - Country:US
Mailing Address - Phone:860-223-2768
Mailing Address - Fax:
Practice Address - Street 1:VA NEWINGTON
Practice Address - Street 2:555 WILLARD AVENUE
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111
Practice Address - Country:US
Practice Address - Phone:860-667-6850
Practice Address - Fax:860-667-6875
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001368363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care