MEDICARE: MARY ANGELINE ANDERSON APRN

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	363LW0102X	Women's Health Nurse Practitioner	APRN9217012	FL
2	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	APRN9217012	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1346475399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ANGELINE ANDERSON APRN

Provider Business Mailing Address
First Line	:	1513 W BUSCH BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-7603
Country	:	US
Telephone Number	:	813-684-2229
Fax Number	:	813-413-8516

Provider Business Practice Location Address
First Line	:	1513 W BUSCH BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-7603
Country	:	US
Telephone Number	:	813-684-2229
Fax Number	:	813-413-8516

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

Provider Enumeration Date	:	05/20/2009
Last Update Date	:	12/29/2020

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