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NPI Code Detail

MEDICARE: MARY WEAVER ARNP

MEDICARE: MARY WEAVER ARNP
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
1363LG0600XGerontology Nurse PractitionerARNP31462342FL

General Provider Information

NPI Number : 1487654729
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY WEAVER ARNP
Provider Business Mailing Address
First Line : PO BOX 561600
Second Line :
City : ROCKLEDGE
State : FL
Zip : 32956-1600
Country : US
Telephone Number : 321-868-7641
Fax Number : 321-868-4135
Provider Business Practice Location Address
First Line : 701 W COCOA BEACH CSWY
Second Line :
City : COCOA BEACH
State : FL
Zip : 32931-3585
Country : US
Telephone Number : 321-868-7641
Fax Number : 321-868-4135
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2005
Last Update Date : 07/08/2007

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