Provider Demographics
NPI:1891398392
Name:SEMIOLI, MARISA ANNE (MSN, FNP-C, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:ANNE
Last Name:SEMIOLI
Suffix:
Gender:F
Credentials:MSN, FNP-C, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1058 FOREST AVE # 10310
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-2419
Mailing Address - Country:US
Mailing Address - Phone:718-818-7425
Mailing Address - Fax:
Practice Address - Street 1:1058 FOREST AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-2419
Practice Address - Country:US
Practice Address - Phone:718-818-7425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346781390200000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program