1588892178 NPI number — MARY ELSIELYNN CARRIGAN ARNP

Table of content: MARY ELSIELYNN CARRIGAN ARNP (NPI 1588892178)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588892178 NPI number — MARY ELSIELYNN CARRIGAN ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARRIGAN
Provider First Name:
MARY
Provider Middle Name:
ELSIELYNN
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:
CARRIGAN
Provider Other First Name:
ELSIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588892178
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 44008
Provider Second Line Business Mailing Address:
UFJP - PROVIDER ENROLLMENT
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32231-4008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-244-3199
Provider Business Mailing Address Fax Number:
904-244-3425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6271 SAINT AUGUSTINE RD
Provider Second Line Business Practice Location Address:
UFJAX - DEPT. OF PEDIATRICES
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32217-2523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-633-0926
Provider Business Practice Location Address Fax Number:
904-633-0461
Provider Enumeration Date:
06/23/2009

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:  ARNP2508052 , 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: 591290544B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 591290544A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0012787-00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001278700 . 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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