Provider Demographics
NPI:1457633745
Name:FREEMAN, MARY P (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:P
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:P
Other - Last Name:LAFLEUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:5501 ROOSEVELT BLVD
Mailing Address - Street 2:ST VINCENT'SFIRST CARE WALK-IN EXPRESS
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-2345
Mailing Address - Country:US
Mailing Address - Phone:904-683-9962
Mailing Address - Fax:904-683-9640
Practice Address - Street 1:5501 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-2345
Practice Address - Country:US
Practice Address - Phone:904-683-9962
Practice Address - Fax:904-683-9640
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9250100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003126406AMedicaid
FLGH875YMedicare PIN
FLP01417470Medicare PIN
FLGH875XMedicare PIN