Provider Demographics
NPI:1578130589
Name:OSORIO, MARY JO (CNA)
Entity Type:Individual
Prefix:
First Name:MARY JO
Middle Name:
Last Name:OSORIO
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9355 113TH ST UNIT 7935
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33775-6914
Mailing Address - Country:US
Mailing Address - Phone:727-288-2345
Mailing Address - Fax:
Practice Address - Street 1:2701 REGENCY OAKS BLVD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-1526
Practice Address - Country:US
Practice Address - Phone:727-288-2345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL248829251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health