Provider Demographics
NPI:1760770929
Name:METHELLUS, MARIE JUNETTE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:JUNETTE
Last Name:METHELLUS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:MARIE
Other - Middle Name:JUNETTE
Other - Last Name:JEAN PIERRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1819 W TENNESSEE ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32304-3356
Mailing Address - Country:US
Mailing Address - Phone:850-576-0147
Mailing Address - Fax:
Practice Address - Street 1:1819 W TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32304-3356
Practice Address - Country:US
Practice Address - Phone:850-576-0147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9246196363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily