Healthcare Provider Details

I. General information

NPI: 1942197215
Provider Name (Legal Business Name): NATHAN PAUL MARCELLINO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 W NEWBERRY RD STE 100
GAINESVILLE FL
32605-6622
US

IV. Provider business mailing address

PO BOX 102222
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 352-332-3900
  • Fax: 352-332-5009
Mailing address:
  • Phone: 239-274-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9120657
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: