Provider Demographics
NPI:1295213346
Name:MCCARTHY, MARY ANGELA (ARNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANGELA
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 FRANKLYN AVE
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-4110
Mailing Address - Country:US
Mailing Address - Phone:321-480-7484
Mailing Address - Fax:
Practice Address - Street 1:200 S HARBOR CITY BLVD STE 401
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1389
Practice Address - Country:US
Practice Address - Phone:321-259-1662
Practice Address - Fax:321-779-7792
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3069812363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNP780OtherMEDICARE PTAN
FLP02182143OtherRRMEDICARE PTAN
FL102086300Medicaid