1295213346 NPI number — MARY ANGELA MCCARTHY ARNP

Table of content: MARY ANGELA MCCARTHY ARNP (NPI 1295213346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295213346 NPI number — MARY ANGELA MCCARTHY ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCARTHY
Provider First Name:
MARY
Provider Middle Name:
ANGELA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295213346
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
530 FRANKLYN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIALANTIC
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32903-4110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-480-7484
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 SARNO RD STE 21
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32935-4992
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-610-1017
Provider Business Practice Location Address Fax Number:
321-610-7449
Provider Enumeration Date:
07/31/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  3069812 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NP780 . This is a "MEDICARE PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 102086300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com