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General NPI Number Information
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NPI Number | 1992570832
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Entity Type | Individual
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Provider Name | MARY FREDERICK LPN
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Gender | Female
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Dates
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Enumeration Date | 11/21/2023
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Last Update Date | 11/21/2023
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Provider Practice Location Address
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Address Line | 4041 ROWAN RD
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City | NEW PORT RICHEY
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State | FL
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Zip | 34653-6121
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Country | US
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Telephone | 727-284-1980
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Fax | 727-284-1981
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Provider Business Mailing Address
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Address Line | 8310 MILL CREEK LN
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City | HUDSON
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State | FL
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Zip | 34667-2527
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Country | US
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Telephone | 727-514-3543
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN5216595
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License Number State | FL
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