Provider Demographics
NPI:1396406286
Name:SCOPELITIS, MARINA EFROSINI
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:EFROSINI
Last Name:SCOPELITIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6048 WINDING LAKE DR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3739
Mailing Address - Country:US
Mailing Address - Phone:561-309-1668
Mailing Address - Fax:
Practice Address - Street 1:2141 S ALTERNATE A1A STE 420
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-4063
Practice Address - Country:US
Practice Address - Phone:561-743-5580
Practice Address - Fax:561-743-5595
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9117844363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program