Provider Demographics
NPI:1134112550
Name:BORISLOW, MARY LEE (ARNP C)
Entity Type:Individual
Prefix:MRS
First Name:MARY LEE
Middle Name:
Last Name:BORISLOW
Suffix:
Gender:F
Credentials:ARNP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 S MARTIN LUTHER KING JR AVE
Mailing Address - Street 2:STE E
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-4172
Mailing Address - Country:US
Mailing Address - Phone:727-443-2920
Mailing Address - Fax:727-443-2726
Practice Address - Street 1:1260 S MARTIN LUTHER KING JR AVE
Practice Address - Street 2:STE E
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-4172
Practice Address - Country:US
Practice Address - Phone:727-443-2920
Practice Address - Fax:727-443-2726
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3044812363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
K2358OtherGROUP MEDICAID
K2358OtherGROUP MEDICAID
E5085ZMedicare ID - Type Unspecified