Provider Demographics
NPI:1669716882
Name:HARTIGAN NAYFIELD, MARYBETH (ARNP)
Entity type:Individual
Prefix:MS
First Name:MARYBETH
Middle Name:
Last Name:HARTIGAN NAYFIELD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARYBETH
Other - Middle Name:
Other - Last Name:HARTIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:155 SE HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429
Mailing Address - Country:US
Mailing Address - Phone:352-563-0184
Mailing Address - Fax:352-563-0195
Practice Address - Street 1:155 SE US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4838
Practice Address - Country:US
Practice Address - Phone:352-563-0184
Practice Address - Fax:352-563-0195
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL860202363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1063484665OtherMEDICARE NPI TYPE 2-ORGANIZATION
FL166716882OtherNPI