Provider Demographics
NPI:1730412529
Name:FREEMAN, MARI PATRICIA (PA-C)
Entity type:Individual
Prefix:
First Name:MARI PATRICIA
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 NE 164TH ST APT 260
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3703
Mailing Address - Country:US
Mailing Address - Phone:818-849-4009
Mailing Address - Fax:
Practice Address - Street 1:1131 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1226
Practice Address - Country:US
Practice Address - Phone:941-444-0011
Practice Address - Fax:603-952-3900
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17251363AM0700X
FLPA9118957363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA17251OtherPHYSICIAN ASSISTANT COMMITTEE