Provider Demographics
NPI:1811667124
Name:PARRISH, MARY A (APRN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:PARRISH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5863 SW 150TH LN
Mailing Address - Street 2:
Mailing Address - City:LAKE BUTLER
Mailing Address - State:FL
Mailing Address - Zip Code:32054-8101
Mailing Address - Country:US
Mailing Address - Phone:352-494-6475
Mailing Address - Fax:
Practice Address - Street 1:4551 W US HIGHWAY 90 STE 101
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-8836
Practice Address - Country:US
Practice Address - Phone:386-319-8178
Practice Address - Fax:386-243-8786
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11015451363LP2300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine