Provider Demographics
NPI:1124413323
Name:PODOLSKIY, MARINA NIKOLAYEVNA (ARNP/ CNM)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:NIKOLAYEVNA
Last Name:PODOLSKIY
Suffix:
Gender:
Credentials:ARNP/ CNM
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Mailing Address - Street 1:2439 BEE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-6304
Mailing Address - Country:US
Mailing Address - Phone:941-222-2146
Mailing Address - Fax:941-378-9120
Practice Address - Street 1:3410 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8112
Practice Address - Country:US
Practice Address - Phone:941-251-8477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020026950367A00000X
WAAP60863109367A00000X
FLAPRN11032140367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2020026103OtherMO MULTI-STATE COMPACT RN LICENSE
WA2108562Medicaid
FL11032140OtherFL STATE APRN CNM LICENSE
WAAP60863109OtherWA STATE ARNP LICENSE
CNM04878OtherAMERICAN MIDWIFERY CERTIFICATION BOARD (AMCB)
WARN60025099OtherWA STATE DEPT OF HEALTH, RN LICENSE