Provider Demographics
NPI:1093739302
Name:MARINO, DEBORAH L (ARNP-C)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:MARINO
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:L
Other - Last Name:GHIOTTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP-C
Mailing Address - Street 1:401 MELBOURNE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-4317
Mailing Address - Country:US
Mailing Address - Phone:321-794-4752
Mailing Address - Fax:321-409-6821
Practice Address - Street 1:730 MALABAR RD STE A
Practice Address - Street 2:
Practice Address - City:MALABAR
Practice Address - State:FL
Practice Address - Zip Code:32950-3140
Practice Address - Country:US
Practice Address - Phone:321-409-6800
Practice Address - Fax:321-409-6821
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1612532363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP 1612532OtherADULT NURSE PRACTIONER