Provider Demographics
NPI:1629734660
Name:MARZILLI, COLLEEN ERIN (FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:ERIN
Last Name:MARZILLI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:DR
Other - First Name:COLLEEN
Other - Middle Name:ERIN
Other - Last Name:MARZILLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, DNP, MBA, RN-BC
Mailing Address - Street 1:360 US HIGHWAY 1 BYP UNIT 102
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7105
Mailing Address - Country:US
Mailing Address - Phone:603-410-6700
Mailing Address - Fax:603-319-8308
Practice Address - Street 1:2116 E RUSK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-9052
Practice Address - Country:US
Practice Address - Phone:903-339-3022
Practice Address - Fax:903-339-3021
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP231226363LF0000X
TX1058689363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1058689OtherTEXAS BOARD OF NURSING