Healthcare Provider Details

I. General information

NPI: 1508936113
Provider Name (Legal Business Name): MARY PENN VARNER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 W DR MARTIN LUTHER KING JR BLVD ST JOSEPH'S CHILDREN'S ADVOCACY CENTER
TAMPA FL
33607-6307
US

IV. Provider business mailing address

1401 E FOWLER AVE STE A ST JOSEPH'S CHILDREN'S ADVOCACY CENTER
TAMPA FL
33612-5513
US

V. Phone/Fax

Practice location:
  • Phone: 813-615-0589
  • Fax: 813-972-2185
Mailing address:
  • Phone: 813-615-0589
  • Fax: 813-972-2185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP1479152
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP1479152
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: