Provider Demographics
NPI:1063025906
Name:MARCELIN, FABIOLA B (NP)
Entity type:Individual
Prefix:
First Name:FABIOLA
Middle Name:B
Last Name:MARCELIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:FABIOLA
Other - Middle Name:
Other - Last Name:BAPTISTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:6820 SAINT AUGUSTINE RD STE A
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2818
Mailing Address - Country:US
Mailing Address - Phone:904-337-1268
Mailing Address - Fax:720-600-0873
Practice Address - Street 1:6820 SAINT AUGUSTINE RD STE A
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2818
Practice Address - Country:US
Practice Address - Phone:904-337-1268
Practice Address - Fax:720-600-0873
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-29
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11009926363LF0000X, 363LP2300X
VA0024185117363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108813900Medicaid