Provider Demographics
NPI:1831578145
Name:JOSEFYK, MARY E (DNP, APRN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:JOSEFYK
Suffix:
Gender:F
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:JOSEFYK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 718
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33862-0718
Mailing Address - Country:US
Mailing Address - Phone:863-659-1079
Mailing Address - Fax:863-659-1317
Practice Address - Street 1:13 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-2603
Practice Address - Country:US
Practice Address - Phone:863-659-1079
Practice Address - Fax:863-659-1317
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN1746942363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLII725ZMedicare PIN