Provider Demographics
NPI:1063885697
Name:SELIN, MARC A (RN)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:A
Last Name:SELIN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:JEAN MARC
Other - Middle Name:A
Other - Last Name:SELIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4918
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32802-4918
Mailing Address - Country:US
Mailing Address - Phone:407-581-9180
Mailing Address - Fax:865-560-7066
Practice Address - Street 1:225 E ROBINSON ST
Practice Address - Street 2:SUITE #130
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-4322
Practice Address - Country:US
Practice Address - Phone:407-581-9180
Practice Address - Fax:865-560-7066
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT111119163W00000X
FLARNP9420516367500000X
MARN280699367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse