1952408403 NPI number — MARY ANN FRITCHEY NP

Table of content: MARY ANN FRITCHEY NP (NPI 1952408403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952408403 NPI number — MARY ANN FRITCHEY NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRITCHEY
Provider First Name:
MARY
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FLOWERS
Provider Other First Name:
MARY
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952408403
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12470 TELECOM DR STE 300W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEMPLE TERRACE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33637-0904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4200 W CYPRESS ST STE 690
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33607-4112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-877-2200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/19/2006

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: 363L00000X , with the licence number:  APN0000005243 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: APN9440724 , 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: 4124059 . This is a "BCBS W PARADIGM" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3908441 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00289425 . This is a "RR MCARE WPARADIGM" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 117183500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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