Provider Demographics
NPI:1609122514
Name:CHASE, MARY ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANN
Last Name:CHASE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3175 W INTERNATIONAL SPEEDWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32124-1019
Mailing Address - Country:US
Mailing Address - Phone:407-319-6363
Mailing Address - Fax:
Practice Address - Street 1:3600 W FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-3501
Practice Address - Country:US
Practice Address - Phone:407-319-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-29
Last Update Date:2012-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 3234262163WC0200X
CA633159163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine