Provider Demographics
NPI:1083197180
Name:MARINO, REBECCA (APRN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:MARINO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:PLOCHARSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP,APRN,RN
Mailing Address - Street 1:20 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06085-1064
Mailing Address - Country:US
Mailing Address - Phone:860-214-5387
Mailing Address - Fax:
Practice Address - Street 1:20 RIVER RD
Practice Address - Street 2:
Practice Address - City:UNIONVILLE
Practice Address - State:CT
Practice Address - Zip Code:06085-1064
Practice Address - Country:US
Practice Address - Phone:860-214-5387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7840363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily