Healthcare Provider Details

I. General information

NPI: 1225339252
Provider Name (Legal Business Name): PAMELA SUE MARCISZEWSKI LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAMELA SUE COLEMAN LPN

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 11/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5421 JONATHAN ST
HASTINGS FL
32145-6606
US

IV. Provider business mailing address

5421 JONATHAN ST
HASTINGS FL
32145-6606
US

V. Phone/Fax

Practice location:
  • Phone: 386-325-6152
  • Fax:
Mailing address:
  • Phone: 386-325-6152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number263877
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN5195624
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: