Provider Demographics
NPI:1760097794
Name:MARCELLIN, LEVI (APRN)
Entity Type:Individual
Prefix:
First Name:LEVI
Middle Name:
Last Name:MARCELLIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 N MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5734
Mailing Address - Country:US
Mailing Address - Phone:407-841-1100
Mailing Address - Fax:
Practice Address - Street 1:1115 E RIDGEWOOD ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5443
Practice Address - Country:US
Practice Address - Phone:407-841-1100
Practice Address - Fax:407-843-7983
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11009037363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112654900Medicaid