MEDICARE: MARY ANN PORTER MSN, CNM, ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	ARNP9167223	FL

General Provider Information

NPI Number	:	1639260334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ANN PORTER MSN, CNM, ARNP

Provider Business Mailing Address
First Line	:	300 NE 6TH ST
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33432-2716
Country	:	US
Telephone Number	:	954-776-1500
Fax Number	:	954-776-1501

Provider Business Practice Location Address
First Line	:	4604 N FEDERAL HWY
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-5206
Country	:	US
Telephone Number	:	954-776-1500
Fax Number	:	954-776-1501

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	07/08/2007

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