Provider Demographics
NPI:1942207766
Name:OATES, MARY JANE (ARNP)
Entity Type:Individual
Prefix:
First Name:MARY JANE
Middle Name:
Last Name:OATES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 SW 33RD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-7405
Mailing Address - Country:US
Mailing Address - Phone:352-873-7788
Mailing Address - Fax:352-873-9397
Practice Address - Street 1:3210 SW 33RD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-7405
Practice Address - Country:US
Practice Address - Phone:352-873-7788
Practice Address - Fax:352-873-9397
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9162745363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9162745OtherNP LICENSE
FLP51456Medicare UPIN