Provider Demographics
NPI:1134154479
Name:WALKER, MARYANN HEROMIN (ARNP PHD)
Entity type:Individual
Prefix:DR
First Name:MARYANN
Middle Name:HEROMIN
Last Name:WALKER
Suffix:
Gender:F
Credentials:ARNP PHD
Other - Prefix:
Other - First Name:MARYANN
Other - Middle Name:A HEROMIN
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-256-7981
Practice Address - Fax:352-265-5427
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1166312363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health