Provider Demographics
NPI:1215798418
Name:NICOLOSI, MARCELLO (RN)
Entity type:Individual
Prefix:MR
First Name:MARCELLO
Middle Name:
Last Name:NICOLOSI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 SHARON CIR
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8348
Mailing Address - Country:US
Mailing Address - Phone:941-276-2552
Mailing Address - Fax:
Practice Address - Street 1:690 SHARON CIR
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8348
Practice Address - Country:US
Practice Address - Phone:941-276-2552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9399693163WC0200X, 163WE0003X, 163WG0000X, 163WC1600X, 163WH0500X, 163WI0500X, 163WM0705X, 163W00000X
174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WH0500XNursing Service ProvidersRegistered NurseHemodialysis
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN9399693OtherFLORIDA BOARD OF NURSING