MEDICARE: BROOKE MARINO, DNP, PMHNP-BC, A PROFESSIONAL NURSING CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1326855941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKE MARINO, DNP, PMHNP-BC, A PROFESSIONAL NURSING CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 880886
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92168-0886
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2645 FINANCIAL CT STE O
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-3554
Country	:	US
Telephone Number	:	425-367-4949
Fax Number	:

Authorized Official
Title or Position	:	PSYCHIATRIC NURSE PRACTITIONER
Name	:	BROOKE MARINO
Credential	:	DNP, PMHNP-BC
Telephone Number	:	425-367-4949

Provider Enumeration Date	:	12/17/2024
Last Update Date	:	01/03/2025

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