Healthcare Provider Details

I. General information

NPI: 1467776278
Provider Name (Legal Business Name): MARY ANN BORGMAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY ANN MCGUIRE

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 05/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 PRUDENTIAL DR UFJAX - PEDIATRIC CARDIOLOGY
JACKSONVILLE FL
32207-8329
US

IV. Provider business mailing address

PO BOX 44008 UFJP - PROVIDER ENROLLMENT
JACKSONVILLE FL
32231-4008
US

V. Phone/Fax

Practice location:
  • Phone: 904-633-4110
  • Fax: 904-633-4111
Mailing address:
  • Phone: 904-244-3199
  • Fax: 904-244-3425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9101430
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: