Provider Demographics
NPI:1700202058
Name:BIRSE, MARY (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BIRSE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11301 SE TEQUESTA TER
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-8146
Mailing Address - Country:US
Mailing Address - Phone:561-744-0211
Mailing Address - Fax:
Practice Address - Street 1:11301 SE TEQUESTA TER
Practice Address - Street 2:
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-8146
Practice Address - Country:US
Practice Address - Phone:561-744-0211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-11
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024187942363LP0808X
FLARNP9239687363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health