Healthcare Provider Details

I. General information

NPI: 1457904336
Provider Name (Legal Business Name): ROBERTA JOYCE MARINO APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8925 COLONIAL CENTER DR STE 1001
FORT MYERS FL
33905-7813
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-5864
  • Fax: 239-343-9650
Mailing address:
  • Phone: 239-343-5864
  • Fax: 239-343-9650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberAPRN11003333
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: