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General NPI Number Information
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NPI Number | 1851606180
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Entity Type | Individual
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Provider Name | MARIE BRYAN MIXON ARNP,BC
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Gender | Female
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Dates
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Enumeration Date | 08/11/2010
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Last Update Date | 08/11/2010
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Provider Practice Location Address
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Address Line | 200 AVENUE F NE
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City | WINTER HAVEN
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State | FL
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Zip | 33881-4131
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Country | US
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Telephone | 863-292-4080
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Fax | 863-292-4017
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Provider Business Mailing Address
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Address Line | 200 AVE F NE WINTER HAVEN HOSPITAL
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City | WINTER HAVEN
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State | FL
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Zip | 33881
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Country | US
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Telephone | 863-292-4080
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Fax | 863-292-4017
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 1876752
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License Number State | FL
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