Provider Demographics
NPI:1558191031
Name:ORELLANA, MARLON ENRIQUE (LMT, RN)
Entity type:Individual
Prefix:
First Name:MARLON
Middle Name:ENRIQUE
Last Name:ORELLANA
Suffix:
Gender:M
Credentials:LMT, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 W ARCTIC ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-1014
Mailing Address - Country:US
Mailing Address - Phone:813-850-3456
Mailing Address - Fax:
Practice Address - Street 1:1808 W ARCTIC ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-1014
Practice Address - Country:US
Practice Address - Phone:813-850-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA75245225700000X
PR38987A163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)