Healthcare Provider Details

I. General information

NPI: 1063316073
Provider Name (Legal Business Name): MARY ABIGAIL SEAMANS AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 NEW AVE NE
PALM BAY FL
32907-2363
US

IV. Provider business mailing address

442 NEW AVE NE
PALM BAY FL
32907-2363
US

V. Phone/Fax

Practice location:
  • Phone: 321-272-1703
  • Fax:
Mailing address:
  • Phone: 321-313-3352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberTBD
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: