Provider Demographics
NPI:1679907042
Name:MARCUCCI, CHRISTINA LAURA (PA-C)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:LAURA
Last Name:MARCUCCI
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 1:1840 MEASE DR
Mailing Address - Street 2:STE 300
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-6602
Mailing Address - Country:US
Mailing Address - Phone:727-785-6011
Mailing Address - Fax:
Practice Address - Street 1:1840 MEASE DR
Practice Address - Street 2:STE 300
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-6602
Practice Address - Country:US
Practice Address - Phone:727-785-6011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107398363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant