Provider Demographics
NPI:1083940472
Name:MAULSBY, MASON S (ARNP)
Entity Type:Individual
Prefix:MS
First Name:MASON
Middle Name:S
Last Name:MAULSBY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 510298
Mailing Address - Street 2:ALLIED CENTER FOR THERAPY / MANUEL GALLEGO MD PA
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33951
Mailing Address - Country:US
Mailing Address - Phone:941-764-6300
Mailing Address - Fax:941-764-7297
Practice Address - Street 1:3460 DEPEW AVE
Practice Address - Street 2:ALLIED CENTER FOR THERAPY
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952
Practice Address - Country:US
Practice Address - Phone:941-764-6300
Practice Address - Fax:941-764-7297
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2158002363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS53916Medicare UPIN
Y5507CMedicare PIN
Y5507AMedicare PIN