Provider Demographics
NPI:1619230901
Name:FREED, MARYANN (LPN)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:FREED
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 E JAMES AVE
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-5559
Mailing Address - Country:US
Mailing Address - Phone:321-356-6858
Mailing Address - Fax:407-886-8316
Practice Address - Street 1:23 E JAMES AVE
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-5559
Practice Address - Country:US
Practice Address - Phone:321-356-6858
Practice Address - Fax:407-886-8316
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5154135372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion