Healthcare Provider Details

I. General information

NPI: 1255418133
Provider Name (Legal Business Name): MARY ALLEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 09/11/2025
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501-1507 BILL BECK BLVD
KISSIMMEE FL
34744
US

IV. Provider business mailing address

1877 FORTUNE RD
KISSIMMEE FL
34744-4428
US

V. Phone/Fax

Practice location:
  • Phone: 407-943-8600
  • Fax:
Mailing address:
  • Phone: 407-943-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number1796282
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: