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NPI Code Detail

MEDICARE: MARY-ELLEN MACDONALD FNP

MEDICARE: MARY-ELLEN MACDONALD FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerARNP9421749FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114205200
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY-ELLEN MACDONALD FNP
Provider Business Mailing Address
First Line : 105 PINE STREET
Second Line :
City : HOMOSASSA
State : FL
Zip : 34446-5201
Country : US
Telephone Number : 207-942-6226
Fax Number :
Provider Business Practice Location Address
First Line : 6038 W NORDLING LOOP
Second Line :
City : CRYSTAL RIVER
State : FL
Zip : 34429-8715
Country : US
Telephone Number : 352-563-5070
Fax Number : 352-795-4322
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2011
Last Update Date : 04/22/2016

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