MEDICARE: MARY PENN VARNER 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
1	363LF0000X	Family Nurse Practitioner	ARNP1479152	FL
2	363LP0200X	Pediatric Nurse Practitioner	ARNP1479152	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	:	1508936113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY PENN VARNER ARNP

Provider Business Mailing Address
First Line	:	1401 E FOWLER AVE STE A
Second Line	:	ST JOSEPH'S CHILDREN'S ADVOCACY CENTER
City	:	TAMPA
State	:	FL
Zip	:	33612-5513
Country	:	US
Telephone Number	:	813-615-0589
Fax Number	:	813-972-2185

Provider Business Practice Location Address
First Line	:	3001 W DR MARTIN LUTHER KING JR BLVD
Second Line	:	ST JOSEPH'S CHILDREN'S ADVOCACY CENTER
City	:	TAMPA
State	:	FL
Zip	:	33607-6307
Country	:	US
Telephone Number	:	813-615-0589
Fax Number	:	813-972-2185

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

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	09/11/2025

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