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General NPI Number Information
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NPI Number | 1659402964
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Entity Type | Individual
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Provider Name | MARK BENEDICT POLLES NP
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Gender | Male
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 09/26/2017
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Provider Practice Location Address
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Address Line | 5637 MARINE PKWY
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-4316
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Country | US
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Telephone | 727-848-1733
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Fax |
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Provider Business Mailing Address
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Address Line | DEPT 1265
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City | DENVER
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State | CO
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Zip | 80256-0001
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Country | US
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Telephone | 866-898-7138
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP95004120
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | ARNP2026672
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN-165625
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License Number State | CO
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