Provider Demographics
NPI:1639260334
Name:PORTER, MARY ANN (MSN, CNM, ARNP)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:MSN, CNM, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 NE 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-2716
Mailing Address - Country:US
Mailing Address - Phone:954-776-1500
Mailing Address - Fax:954-776-1501
Practice Address - Street 1:4604 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5206
Practice Address - Country:US
Practice Address - Phone:954-776-1500
Practice Address - Fax:954-776-1501
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9167223363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology