Provider Demographics
NPI:1992194005
Name:MOBLEY, ANN MARIE (LAC)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:MARIE
Last Name:MOBLEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 4TH ST W
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-4269
Mailing Address - Country:US
Mailing Address - Phone:813-601-6699
Mailing Address - Fax:
Practice Address - Street 1:435 10TH AVE W STE 200
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-5031
Practice Address - Country:US
Practice Address - Phone:941-807-2077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2099171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist