MEDICARE: FABIOLA B MARCELIN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	11009926	FL
2	363LP2300X	Primary Care Nurse Practitioner	0024185117	VA
3	363LP2300X	Primary Care Nurse Practitioner	11009926	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063025906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FABIOLA B MARCELIN NP

Provider Business Mailing Address
First Line	:	6820 SAINT AUGUSTINE RD STE A
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2818
Country	:	US
Telephone Number	:	904-337-1268
Fax Number	:	720-600-0873

Provider Business Practice Location Address
First Line	:	6820 SAINT AUGUSTINE RD STE A
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2818
Country	:	US
Telephone Number	:	904-337-1268
Fax Number	:	720-600-0873

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2020
Last Update Date	:	01/12/2025

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