Healthcare Provider Details

I. General information

NPI: 1942712179
Provider Name (Legal Business Name): MS. MARY ANN SPRINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2017
Last Update Date: 10/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7108 S KANNER HWY
STUART FL
34997-7462
US

IV. Provider business mailing address

2929 SE OCEAN BLVD APT L1
STUART FL
34996-2712
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 772-485-9335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number017422400
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: