Healthcare Provider Details

I. General information

NPI: 1316531023
Provider Name (Legal Business Name): MARY ANN WOOTEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 AL-59
SUMMERDALE AL
36580
US

IV. Provider business mailing address

1718 E OLIVE RD
PENSACOLA FL
32514-7553
US

V. Phone/Fax

Practice location:
  • Phone: 251-989-9400
  • Fax:
Mailing address:
  • Phone: 850-479-4456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-137581
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11011171
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: