Healthcare Provider Details

I. General information

NPI: 1730432899
Provider Name (Legal Business Name): MARCELLINE L GIRLIE DNP, ARNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARCELLINE LAZARRE DNP, ARNP-BC

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 OCOEE APOPKA RD STE 106
OCOEE FL
34761-5344
US

IV. Provider business mailing address

2222 OCOEE APOPKA RD STE 106
OCOEE FL
34761-5344
US

V. Phone/Fax

Practice location:
  • Phone: 407-698-5092
  • Fax: 407-550-3790
Mailing address:
  • Phone: 239-357-1945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9350985
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP9350985
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: