Provider Demographics
NPI:1598919714
Name:PETERZELL, MARCIA KAY (APRN)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:KAY
Last Name:PETERZELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:MARCIA
Other - Middle Name:KAY
Other - Last Name:ERHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1275 W GRANADA BLVD STE 3A
Mailing Address - Street 2:COASTAL PEDIATRICS LLC
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174
Mailing Address - Country:US
Mailing Address - Phone:386-672-1490
Mailing Address - Fax:386-672-1682
Practice Address - Street 1:1275 W GRANADA BLVD. STE 3A
Practice Address - Street 2:COASTAL PEDIATRICS LLC
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174
Practice Address - Country:US
Practice Address - Phone:386-672-1490
Practice Address - Fax:386-672-1682
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN3136772363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP3136772OtherSTOFFL/DOH