MEDICARE: MARY LEE

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
1	163W00000X	Registered Nurse	9349997	FL

General Provider Information

NPI Number	:	1336074111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY LEE

Provider Business Mailing Address
First Line	:	6222 43RD AVE N
Second Line	:
City	:	KENNETH CITY
State	:	FL
Zip	:	33709-5020
Country	:	US
Telephone Number	:	727-272-0534
Fax Number	:	727-272-0534

Provider Business Practice Location Address
First Line	:	6222 43RD AVE N
Second Line	:
City	:	KENNETH CITY
State	:	FL
Zip	:	33709-5020
Country	:	US
Telephone Number	:	727-272-0534
Fax Number	:	727-272-0534

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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Directions to “ MARY LEE ” Practice Location

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