Healthcare Provider Details

I. General information

NPI: 1760097794
Provider Name (Legal Business Name): LEVI MARCELLIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1876 NIGHTINGALE LN
TAVARES FL
32778-4359
US

IV. Provider business mailing address

22 UNDERWOOD ST
ORLANDO FL
32806-1110
US

V. Phone/Fax

Practice location:
  • Phone: 352-742-4447
  • Fax: 352-742-4448
Mailing address:
  • Phone: 407-648-3800
  • Fax: 407-872-7754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11009037
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11009037
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: