Provider Demographics
NPI:1326156159
Name:MCCORMICK, MARIE LOUISE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:LOUISE
Last Name:MCCORMICK
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:PO BOX 864414
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-4414
Mailing Address - Country:US
Mailing Address - Phone:072-002-3554
Mailing Address - Fax:
Practice Address - Street 1:60 MEMORIAL MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-5980
Practice Address - Country:US
Practice Address - Phone:386-586-2000
Practice Address - Fax:317-705-5047
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9331643363L00000X
GA214963363L00000X
RINPP37255363L00000X
FLAPRN9331643363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
RISSD68942Medicaid
RI007061013Medicare PIN
RI37255OtherLICENSE NP
GA214963OtherLICENSE NP
11827279OtherCAQH