Healthcare Provider Details

I. General information

NPI: 1295667830
Provider Name (Legal Business Name): MARY HELEN DEL MAR PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 COLLEGE PKWY
GULF BREEZE FL
32563-2714
US

IV. Provider business mailing address

1410 COLLEGE PKWY
GULF BREEZE FL
32563-2714
US

V. Phone/Fax

Practice location:
  • Phone: 575-910-8565
  • Fax: 575-910-8565
Mailing address:
  • Phone: 575-910-8565
  • Fax: 575-910-8565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberAPRN11044089
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: