Provider Demographics
NPI:1407838873
Name:KLADDE, MARY LU (ARNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LU
Last Name:KLADDE
Suffix:
Gender:F
Credentials:ARNP, FNP-BC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:LU
Other - Last Name:GODDEYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 100286
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0286
Mailing Address - Country:US
Mailing Address - Phone:352-265-0535
Mailing Address - Fax:352-265-1060
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-4833
Practice Address - Country:US
Practice Address - Phone:352-265-0535
Practice Address - Fax:352-265-1060
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN1704522363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL660119700Medicaid
FLP01495Medicare UPIN