Provider Demographics
NPI:1245446616
Name:PUHR, MARY CATHERINE (ARNPC)
Entity type:Individual
Prefix:MRS
First Name:MARY CATHERINE
Middle Name:
Last Name:PUHR
Suffix:
Gender:F
Credentials:ARNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41741 IRIS ST
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32736
Mailing Address - Country:US
Mailing Address - Phone:352-551-4775
Mailing Address - Fax:
Practice Address - Street 1:2300 KURT ST
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726
Practice Address - Country:US
Practice Address - Phone:352-589-2501
Practice Address - Fax:352-589-4041
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1874522ARNP363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Not Answered363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
S29980Medicare UPIN
FLY4889Medicare ID - Type Unspecified