Provider Demographics
NPI:1942538046
Name:LEGLER, MARY ANN SPENCER (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:SPENCER
Last Name:LEGLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:120 40TH STREET CT NW
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-2046
Mailing Address - Country:US
Mailing Address - Phone:941-747-4802
Mailing Address - Fax:942-747-2371
Practice Address - Street 1:2027 MANATEE AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-5836
Practice Address - Country:US
Practice Address - Phone:941-747-4802
Practice Address - Fax:941-747-2371
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP 2139992364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY3947OtherBLUE CROSS BLUE SHIELD OF FLORIDA