Healthcare Provider Details

I. General information

NPI: 1295844025
Provider Name (Legal Business Name): MARY MAGDALENE CORTES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 DOUGLAS AVE SUITE 104
ALTAMONTE SPRINGS FL
32714-5206
US

IV. Provider business mailing address

PO BOX 6250
CHARLOTTESVILLE VA
22906-6250
US

V. Phone/Fax

Practice location:
  • Phone: 434-977-9719
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number547140
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: