Provider Demographics
NPI:1518908813
Name:RICHARD MARINO ARNP INC
Entity Type:Organization
Organization Name:RICHARD MARINO ARNP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:321-728-7651
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:321-728-7651
Mailing Address - Fax:321-952-5643
Practice Address - Street 1:401 MELBOURNE AVE
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-4317
Practice Address - Country:US
Practice Address - Phone:321-728-7651
Practice Address - Fax:321-952-5643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1218162363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY 3560YMedicare ID - Type UnspecifiedPROVIDER
FLS 59747Medicare UPIN