Provider Demographics
NPI:1942197215
Name:MARCELLINO, NATHAN PAUL (PA-C)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:PAUL
Last Name:MARCELLINO
Suffix:
Gender:M
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 1:3705 SW 27TH ST APT 913
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-7021
Mailing Address - Country:US
Mailing Address - Phone:919-634-7698
Mailing Address - Fax:
Practice Address - Street 1:3705 SW 27TH ST APT 913
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-7021
Practice Address - Country:US
Practice Address - Phone:919-634-7698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant