MEDICARE: MARY M CALLAHAN 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	3060172	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	:	1831151638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY M CALLAHAN ARNP

Provider Business Mailing Address
First Line	:	1926 LAKE SUE DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-1657
Country	:	US
Telephone Number	:	407-252-6719
Fax Number	:

Provider Business Practice Location Address
First Line	:	1925 MIZELL AVE
Second Line	:	SUITE 201
City	:	WINTER PARK
State	:	FL
Zip	:	32792-4106
Country	:	US
Telephone Number	:	407-628-0448
Fax Number	:

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

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	06/11/2010

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