Individual provider Active NPI

Marissa A Nelson, APRN

  • Nurse Practitioner
  • Tallahassee, FL
National Provider Identifier
1972198802
Registry record updated Dec 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
APRN11011915 Issued in FL
Practice address
2351 Phillips Rd
Tallahassee, FL 32308-5333
Phone
(508) 877-8166
Fax
(850) 877-0431
NPI assigned
Mar 3, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN11011915 FL
Nurse Practitioner 363L00000X APRN11011915 FL Primary

Addresses

Primary practice location

2351 Phillips Rd
Tallahassee, FL 32308-5333

Mailing address

2353 Mission Rd Apt 113
Tallahassee, FL 32304-2662
Phone (850) 728-3745

Other names 1

  • Marissa A Hicks Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210526000417 FL Practitioner - Nurse Practitioner 2668871542 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mana Health Partners PAGroup PAC ID 3971952813, 102 clinicians

Practice addresses (Care Compare)

1650 Phillips Rd
Tallahassee, FL 32308-5304
Phone (732) 719-5039

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN11011915FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Cancer Specialists & Research Institute, LLC CurrentSince May 3, 2021 Accepting new patients

Locations

4371 Veronica S Shoemaker Blvd
Fort Myers, FL 33916
Phone (239) 432-8500

1970 Golf St
Fl Cancer
Sarasota, FL 34236
Phone (941) 795-3780

2626 Care Dr
Ste 101
Tallahassee, FL 32308
Phone (850) 219-5830

2351 Phillips Rd
Tallahassee, FL 32308
Phone (850) 877-8166

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671580800000",
    "number": "1972198802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2353 MISSION RD APT 113",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323042662",
            "telephone_number": "850-728-3745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2351 PHILLIPS RD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323085333",
            "telephone_number": "508-877-8166",
            "fax_number": "850-877-0431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "MARISSA",
        "middle_name": "A",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-03",
        "last_updated": "2022-12-21",
        "certification_date": "2022-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN11011915",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "APRN11011915",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARISSA",
            "last_name": "HICKS",
            "middle_name": "A",
            "credential": "APRN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tallahassee, FL

Sources for this page

Verify at the official NPI Registry.