Provider Demographics
NPI:1609939057
Name:GILLEN, MARLENE M (ARNP)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:M
Last Name:GILLEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARLENE
Other - Middle Name:MARIE
Other - Last Name:KLEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 TAMPA GENERAL CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3571
Mailing Address - Country:US
Mailing Address - Phone:813-844-7000
Mailing Address - Fax:813-844-3005
Practice Address - Street 1:1 TAMPA GENERAL CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3571
Practice Address - Country:US
Practice Address - Phone:813-844-7000
Practice Address - Fax:813-844-3005
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1996272363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308071400Medicaid
FL308071400Medicaid
FLAB189ZMedicare PIN