Healthcare Provider Details

I. General information

NPI: 1609025295
Provider Name (Legal Business Name): MARY TAMMY SPITZER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 09/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD BOX 100337
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

2316 NW 42ND PL
GAINESVILLE FL
32605-1676
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0680
  • Fax: 352-265-1101
Mailing address:
  • Phone: 352-262-6785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number3205272
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: