Provider Demographics
NPI:1386005817
Name:ADAMS, MARY BETH
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:BETH
Other - Last Name:STRODE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1537 S ALAFAYA TRL
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-8957
Mailing Address - Country:US
Mailing Address - Phone:407-203-3888
Mailing Address - Fax:
Practice Address - Street 1:1537 S ALAFAYA TRL
Practice Address - Street 2:SUITE 104
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-8957
Practice Address - Country:US
Practice Address - Phone:407-203-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3106362363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP3106362OtherLICENSE NUMBER