Provider Demographics
NPI:1154960730
Name:SCOTT, MARISSA CHERVA (LPN)
Entity type:Individual
Prefix:MS
First Name:MARISSA
Middle Name:CHERVA
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 FREEMAN RD NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-1866
Mailing Address - Country:US
Mailing Address - Phone:321-987-1895
Mailing Address - Fax:
Practice Address - Street 1:2822 TEMPLE TER
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2065
Practice Address - Country:US
Practice Address - Phone:321-987-1895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-31
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5241613164W00000X
376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No164W00000XNursing Service ProvidersLicensed Practical Nurse