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NPI Code Detail

MEDICARE: MARY CELESTE GREEN APRN

MEDICARE: MARY CELESTE GREEN 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
1363L00000XNurse PractitionerAPRN11034410FL
2363LF0000XFamily Nurse PractitionerAPRN11034410FL

General Provider Information

NPI Number : 1417786096
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY CELESTE GREEN APRN
Provider Business Mailing Address
First Line : PO BOX 102222
Second Line :
City : ATLANTA
State : GA
Zip : 30368-2222
Country : US
Telephone Number : 239-274-8200
Fax Number :
Provider Business Practice Location Address
First Line : 3730 7TH TER STE 101
Second Line :
City : VERO BEACH
State : FL
Zip : 32960-6556
Country : US
Telephone Number : 772-567-2332
Fax Number : 844-812-2806
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2024
Last Update Date : 12/08/2025

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Directions to “ MARY CELESTE GREEN APRN” Practice Location

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