Provider Demographics
NPI:1295999266
Name:ST JOHN, MARK PATRICK (FNP)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:PATRICK
Last Name:ST JOHN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7740 MEIGS RD
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-9757
Mailing Address - Country:US
Mailing Address - Phone:315-638-2521
Mailing Address - Fax:315-638-2552
Practice Address - Street 1:7740 MEIGS RD
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-9757
Practice Address - Country:US
Practice Address - Phone:315-638-2521
Practice Address - Fax:315-638-2552
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335622363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily