Provider Demographics
NPI:1356331417
Name:MARINO, RONI K (PA-C)
Entity type:Individual
Prefix:
First Name:RONI
Middle Name:K
Last Name:MARINO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 MANATEE AVE W STE 100
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-4954
Mailing Address - Country:US
Mailing Address - Phone:941-847-7920
Mailing Address - Fax:941-757-2291
Practice Address - Street 1:2424 MANATEE AVE W STE 100
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-4954
Practice Address - Country:US
Practice Address - Phone:941-847-7920
Practice Address - Fax:941-757-2291
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3427363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001771100Medicaid
FLY01TAOtherBCBS
FLE2510ZMedicare PIN
FLS79914Medicare UPIN