Provider Demographics
NPI:1629543129
Name:MARROLETTI, LYNDA CAROL (AGPCNP-C)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:CAROL
Last Name:MARROLETTI
Suffix:
Gender:F
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 LONDON BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3405
Mailing Address - Country:US
Mailing Address - Phone:757-861-9010
Mailing Address - Fax:
Practice Address - Street 1:2929 LONDON BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3405
Practice Address - Country:US
Practice Address - Phone:757-861-9010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0101222-C-NP363L00000X
VA0024177066363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner