MEDICARE: MRS. MARY KATHRYN ELLERMEYER-STAPLETON ARNP-C, ANP

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	363LA2200X	Adult Health Nurse Practitioner	ARNP2513482	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	:	1710284617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY KATHRYN ELLERMEYER-STAPLETON ARNP-C, ANP

Provider Business Mailing Address
First Line	:	PO BOX 91630
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33804-1630
Country	:	US
Telephone Number	:	863-660-2673
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 BAKER AVE
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-8839
Country	:	US
Telephone Number	:	863-421-3204
Fax Number	:

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

Provider Enumeration Date	:	02/12/2011
Last Update Date	:	09/20/2016

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