Healthcare Provider Details

I. General information

NPI: 1952377624
Provider Name (Legal Business Name): MARIAN J SERVIDIO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W AIRPORT BLVD
SANFORD FL
32773-5489
US

IV. Provider business mailing address

611 WEYBRIDGE CT
LAKE MARY FL
32746-3796
US

V. Phone/Fax

Practice location:
  • Phone: 407-665-3354
  • Fax: 407-665-3213
Mailing address:
  • Phone: 407-330-3014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN1149342
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: