Healthcare Provider Details

I. General information

NPI: 1194159301
Provider Name (Legal Business Name): MARY ANN FERGUSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2013
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10494 NORTHCLIFFE BLVD
SPRING HILL FL
34608-3656
US

IV. Provider business mailing address

3925 N LECANTO HWY
BEVERLY HILLS FL
34465-3507
US

V. Phone/Fax

Practice location:
  • Phone: 352-686-3991
  • Fax: 352-666-0393
Mailing address:
  • Phone: 352-697-7336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP 9359315
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9359315
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: