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NPI Code Detail

MEDICARE: MARY K COUSINS NP

MEDICARE: MARY K COUSINS NP
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
1363LF0000XFamily Nurse Practitioner9172104FL
2363LF0000XFamily Nurse PractitionerF3330731NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659467157
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY K COUSINS NP
Provider Business Mailing Address
First Line : 443 NE 100 STREET
Second Line :
City : MIAMI SHORES
State : FL
Zip : 33138-2446
Country : US
Telephone Number : 305-762-7305
Fax Number :
Provider Business Practice Location Address
First Line : 1611 NW 12 AVENUE
Second Line : EAST TOWER 6005
City : MIAMI
State : FL
Zip : 33136-1005
Country : US
Telephone Number : 305-585-5905
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 06/24/2009

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