Healthcare Provider Details

I. General information

NPI: 1336547652
Provider Name (Legal Business Name): MARY ELIZABETH FOSTER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2014
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 E ALTAMONTE DR STE 328
ALTAMONTE SPRINGS FL
32701-5103
US

IV. Provider business mailing address

661 E ALTAMONTE DR STE 328
ALTAMONTE SPRINGS FL
32701-5103
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-5204
  • Fax: 407-303-5205
Mailing address:
  • Phone: 407-303-5204
  • Fax: 407-303-5205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberARNP9327743
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 743652
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: