Provider Demographics
NPI:1164647970
Name:MCGRATH, ANN CHRISTENSEN (APRN, CNM)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:CHRISTENSEN
Last Name:MCGRATH
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:CHRISTENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 25317
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-5317
Mailing Address - Country:US
Mailing Address - Phone:813-286-0033
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:1411 S 14TH ST STE D
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-3092
Practice Address - Country:US
Practice Address - Phone:904-321-0064
Practice Address - Fax:904-491-3113
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9183318363L00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308330600Medicaid
FLAD977ZMedicare PIN