Provider Demographics
NPI:1437982352
Name:PRINCE, MARINA CARMELA (NP)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:CARMELA
Last Name:PRINCE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARINA
Other - Middle Name:
Other - Last Name:PIZZOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 FOREST VIEW LN
Mailing Address - Street 2:
Mailing Address - City:MINOA
Mailing Address - State:NY
Mailing Address - Zip Code:13116-1937
Mailing Address - Country:US
Mailing Address - Phone:607-591-3031
Mailing Address - Fax:
Practice Address - Street 1:301 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1899
Practice Address - Country:US
Practice Address - Phone:315-448-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF354444-01207PE0004X
NY354444363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services