Healthcare Provider Details

I. General information

NPI: 1790602829
Provider Name (Legal Business Name): MARY E DIGIORGIO, APRN-BC, MSN,PLC INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 BULLDOG BLVD STE 200-B
MELBOURNE FL
32901-3332
US

IV. Provider business mailing address

95 BULLDOG BLVD STE 200-B
MELBOURNE FL
32901-3332
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARY DIGIORGIO
Title or Position: OWNER
Credential: NP
Phone: 321-770-2138