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General NPI Number Information
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NPI Number | 1023068962
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Entity Type | Individual
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Provider Name | MARY ANN BECK CORSELLO PA
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Gender | Female
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 07/30/2013
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Provider Practice Location Address
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Address Line | 525 OKEECHOBEE BLVD CITY TOWER PLACE 14TH FLOOR
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-6349
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Country | US
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Telephone | 561-804-0200
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Fax | 561-804-0222
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Provider Business Mailing Address
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Address Line | 525 OKEECHOBEE BLVD CITY TOWER PLACE 14TH FLOOR
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-6349
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Country | US
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Telephone | 561-804-0200
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Fax | 561-804-0222
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9106112
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License Number State | FL
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