Healthcare Provider Details

I. General information

NPI: 1437950581
Provider Name (Legal Business Name): KATHLEEN MARINELLO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 CENTRAL AVE
FAR ROCKAWAY NY
11691-4002
US

IV. Provider business mailing address

1612 CENTRAL AVE
FAR ROCKAWAY NY
11691-4002
US

V. Phone/Fax

Practice location:
  • Phone: 718-223-5820
  • Fax:
Mailing address:
  • Phone: 718-223-5820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP.AP.70052926-NP
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95037068
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11038368
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1216527
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14233414-4405
License Number StateUT
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number357749
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: