MEDICARE: MARY ELSIELYNN CARRIGAN 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	ARNP2508052	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588892178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELSIELYNN CARRIGAN ARNP

Provider Business Mailing Address
First Line	:	PO BOX 44008
Second Line	:	UFJP - PROVIDER ENROLLMENT
City	:	JACKSONVILLE
State	:	FL
Zip	:	32231-4008
Country	:	US
Telephone Number	:	904-244-3199
Fax Number	:	904-244-3425

Provider Business Practice Location Address
First Line	:	6271 SAINT AUGUSTINE RD
Second Line	:	UFJAX - DEPT. OF PEDIATRICES
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2523
Country	:	US
Telephone Number	:	904-633-0926
Fax Number	:	904-633-0461

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

Provider Enumeration Date	:	06/23/2009
Last Update Date	:	01/12/2012

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