Provider Demographics
NPI:1326583550
Name:MARUCUT, FELICA L (AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:FELICA
Middle Name:L
Last Name:MARUCUT
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 GRESHAM DR
Mailing Address - Street 2:STE 8630B
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1904
Mailing Address - Country:US
Mailing Address - Phone:757-388-6115
Mailing Address - Fax:757-275-9998
Practice Address - Street 1:835 GLENROCK RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3767
Practice Address - Country:US
Practice Address - Phone:757-252-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-25
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174354363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care