Provider Demographics
NPI:1063557452
Name:REID, MARY IRELAND (RN, AP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:IRELAND
Last Name:REID
Suffix:
Gender:F
Credentials:RN, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 NE 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-3437
Mailing Address - Country:US
Mailing Address - Phone:352-377-4128
Mailing Address - Fax:
Practice Address - Street 1:1031 NW 6TH ST STE D1
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4277
Practice Address - Country:US
Practice Address - Phone:352-224-5085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL#AP1896171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist