Healthcare Provider Details

I. General information

NPI: 1467701532
Provider Name (Legal Business Name): MARY ELIZABETH DIGIORGIO AAPRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 BULLDOG BLVD STE 200
MELBOURNE FL
32901-3188
US

IV. Provider business mailing address

95 BULLDOG BLVD STE 200
MELBOURNE FL
32901-3188
US

V. Phone/Fax

Practice location:
  • Phone: 321-770-2138
  • Fax: 321-341-4473
Mailing address:
  • Phone: 321-770-2138
  • Fax: 321-341-4473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP3001392
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: