Provider Demographics
NPI:1609062975
Name:NEMENTH, MARY ANNE (CST)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:ANNE
Last Name:NEMENTH
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1106 DRUID RD S
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3846
Mailing Address - Country:US
Mailing Address - Phone:727-446-5681
Mailing Address - Fax:727-462-6251
Practice Address - Street 1:1106 DRUID RD S
Practice Address - Street 2:SUITE 301
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3846
Practice Address - Country:US
Practice Address - Phone:727-446-5681
Practice Address - Fax:727-462-6251
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLF0034363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF01034OtherCST