Provider Demographics
NPI:1225735996
Name:DOYLE, MARY CLARE (NNP)
Entity Type:Individual
Prefix:
First Name:MARY CLARE
Middle Name:
Last Name:DOYLE
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:MARYCLARE
Other - Middle Name:
Other - Last Name:DOYLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NNP
Mailing Address - Street 1:109 W FORTUNE ST APT 1227
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-3209
Mailing Address - Country:US
Mailing Address - Phone:513-490-7878
Mailing Address - Fax:
Practice Address - Street 1:3030 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6308
Practice Address - Country:US
Practice Address - Phone:813-879-4730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11027156363LN0000X
OHRN.471416163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal