Provider Demographics
NPI:1457904336
Name:MARINO, ROBERTA JOYCE (APRN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:JOYCE
Last Name:MARINO
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-5864
Mailing Address - Fax:239-343-9650
Practice Address - Street 1:8925 COLONIAL CENTER DR STE 1001
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-7813
Practice Address - Country:US
Practice Address - Phone:239-343-5864
Practice Address - Fax:239-343-9650
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11003333364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103810300Medicaid