Provider Demographics
NPI:1063484665
Name:MARYBETH NAYFIELD
Entity Type:Organization
Organization Name:MARYBETH NAYFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARYBETH
Authorized Official - Middle Name:H
Authorized Official - Last Name:NAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:352-527-0068
Mailing Address - Street 1:3700 W SOVEREIGN PATH
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-8071
Mailing Address - Country:US
Mailing Address - Phone:352-527-0068
Mailing Address - Fax:352-620-7565
Practice Address - Street 1:3700 W SOVEREIGN PATH
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-8071
Practice Address - Country:US
Practice Address - Phone:352-527-0068
Practice Address - Fax:352-620-7565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN860202363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS54062Medicare UPIN
FLE0601Medicare ID - Type Unspecified