Provider Demographics
NPI:1922162429
Name:WHITE, MARY PATRICIA (CPNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:PATRICIA
Last Name:WHITE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1463 NECTARINE ST
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-3027
Mailing Address - Country:US
Mailing Address - Phone:904-491-0177
Mailing Address - Fax:904-491-3173
Practice Address - Street 1:1463 NECTARINE ST
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-3027
Practice Address - Country:US
Practice Address - Phone:904-441-0177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9469166208000000X
DEL1-0029636363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics