Healthcare Provider Details

I. General information

NPI: 1851606180
Provider Name (Legal Business Name): MARIE BRYAN MIXON ARNP,BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 AVENUE F NE
WINTER HAVEN FL
33881-4131
US

IV. Provider business mailing address

200 AVE F NE WINTER HAVEN HOSPITAL
WINTER HAVEN FL
33881
US

V. Phone/Fax

Practice location:
  • Phone: 863-292-4080
  • Fax: 863-292-4017
Mailing address:
  • Phone: 863-292-4080
  • Fax: 863-292-4017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1876752
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: