MEDICARE: ALLEN MARYASIS FNP-C

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	11030948	FL
2	207Q00000X	Family Medicine Physician	11030948	FL

General Provider Information

NPI Number	:	1699539007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLEN MARYASIS FNP-C

Provider Business Mailing Address
First Line	:	413 E PALMETTO PARK RD APT 740
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33432-5190
Country	:	US
Telephone Number	:	917-968-3162
Fax Number	:

Provider Business Practice Location Address
First Line	:	413 E PALMETTO PARK RD APT 740
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33432-5190
Country	:	US
Telephone Number	:	917-968-3162
Fax Number	:

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

Provider Enumeration Date	:	02/07/2024
Last Update Date	:	04/17/2026

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