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General NPI Number Information
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NPI Number | 1366488249
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Entity Type | Individual
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Provider Name | MARY P. TYREE P.A.
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Gender | Female
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 360 S 10TH ST
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City | HAINES CITY
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State | FL
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Zip | 33844-5602
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Country | US
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Telephone | 863-547-0755
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 S DOUGLAS RD STE 308
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City | CORAL GABLES
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State | FL
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Zip | 33134-6134
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Country | US
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Telephone | 561-244-3643
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Fax | 863-606-6737
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9102323
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License Number State | FL
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