Provider Demographics
NPI:1992774475
Name:MARINO, RICHARD M (ARNP)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:M
Last Name:MARINO
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 MELBOURNE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-4317
Mailing Address - Country:US
Mailing Address - Phone:321-794-4752
Mailing Address - Fax:866-268-1619
Practice Address - Street 1:401 MELBOURNE AVE
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-4317
Practice Address - Country:US
Practice Address - Phone:321-794-4752
Practice Address - Fax:866-268-1619
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1218162363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304356800Medicaid
FL304356800Medicaid
FLY3560UMedicare PIN