Healthcare Provider Details

I. General information

NPI: 1831330604
Provider Name (Legal Business Name): MARY E VONMERVELDT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY E SHREVE

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E PALMETTO ST
WAUCHULA FL
33873-2732
US

IV. Provider business mailing address

950 COUNTY ROAD 17A W
AVON PARK FL
33825-2164
US

V. Phone/Fax

Practice location:
  • Phone: 863-773-2111
  • Fax: 863-773-3284
Mailing address:
  • Phone: 863-452-3000
  • Fax: 863-452-3077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP9267080
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: