Provider Demographics
NPI:1801905435
Name:PINNER, MARY ANNE (AUD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANNE
Last Name:PINNER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7135 NW 11TH PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-3143
Mailing Address - Country:US
Mailing Address - Phone:352-331-0090
Mailing Address - Fax:352-331-0094
Practice Address - Street 1:7135 NW 11TH PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605
Practice Address - Country:US
Practice Address - Phone:352-331-0090
Practice Address - Fax:352-331-0094
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY761231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL231H00000XOtherTAXONONMY
FL600077100Medicaid
FLS1728Medicare UPIN