Provider Demographics
NPI:1093938128
Name:MARINELLI, JANET MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:MARIE
Last Name:MARINELLI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:MARIE
Other - Last Name:IOGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4800 N 22ND ST STE 210
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4963
Mailing Address - Country:US
Mailing Address - Phone:602-955-1000
Mailing Address - Fax:602-508-4830
Practice Address - Street 1:40 CAPRI BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5661
Practice Address - Country:US
Practice Address - Phone:602-955-1000
Practice Address - Fax:602-508-4830
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3604363AS0400X, 363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3604OtherLICENSE
AZ378599Medicaid