Provider Demographics
NPI:1417024696
Name:MARCELIN, NITHCHEL (PA-C)
Entity Type:Individual
Prefix:MS
First Name:NITHCHEL
Middle Name:
Last Name:MARCELIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:NITHCHEL
Other - Middle Name:
Other - Last Name:MARCELIN-APPADOO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:770 SE INDIAN ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-5604
Mailing Address - Country:US
Mailing Address - Phone:772-919-8685
Mailing Address - Fax:772-210-6675
Practice Address - Street 1:3670 NE INDIAN RIVER DR
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4116
Practice Address - Country:US
Practice Address - Phone:772-919-8685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103611363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9103611OtherFLORIDA LICENSE
FLAK449VMedicare PIN
FLAK449WMedicare PIN