MEDICARE: MARY TOLLE

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	163W00000X	Registered Nurse	RN9675633	FL

General Provider Information

NPI Number	:	1851259824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY TOLLE

Provider Business Mailing Address
First Line	:	2694 SAN MARCO WAY
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884-3577
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2694 SAN MARCO WAY
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884-3577
Country	:	US
Telephone Number	:	253-320-5100
Fax Number	:

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

Provider Enumeration Date	:	01/09/2026
Last Update Date	:	01/09/2026

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Directions to “ MARY TOLLE ” Practice Location

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