Healthcare Provider Details

I. General information

NPI: 1942650320
Provider Name (Legal Business Name): MARY WALTER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 06/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 39TH ST W
BRADENTON FL
34205-2454
US

IV. Provider business mailing address

700 8TH AVE W SUITE 101
PALMETTO FL
34221-4737
US

V. Phone/Fax

Practice location:
  • Phone: 941-748-4602
  • Fax: 941-747-9230
Mailing address:
  • Phone: 941-776-4000
  • Fax: 941-845-4963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP1753342
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: