Provider Demographics
NPI:1881730505
Name:FALASCO, MARIANNE RITA (ARNP-BC,)
Entity type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:RITA
Last Name:FALASCO
Suffix:
Gender:F
Credentials:ARNP-BC,
Other - Prefix:PROF
Other - First Name:MARIANNE
Other - Middle Name:RITA
Other - Last Name:FALASCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:261 W GARDENIA DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7338
Mailing Address - Country:US
Mailing Address - Phone:386-801-1253
Mailing Address - Fax:
Practice Address - Street 1:211 S VOLUSIA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-5839
Practice Address - Country:US
Practice Address - Phone:386-775-7500
Practice Address - Fax:386-775-1904
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN2909852363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260130300Medicaid
FLY9374AMedicare PIN
FLY9374AMedicare PIN