Provider Demographics
NPI:1467831040
Name:PHILIP, MARY (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:PHILIP
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:VARKEY
Other - Last Name:VARAMPATHU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:13203 CHATTANOOGA LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-4005
Mailing Address - Country:US
Mailing Address - Phone:407-232-5641
Mailing Address - Fax:
Practice Address - Street 1:13203 CHATTANOOGA LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-4005
Practice Address - Country:US
Practice Address - Phone:407-232-5641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2988912363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health