Provider Demographics
NPI:1124064332
Name:BARONE, MARIO J (ARNP)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:J
Last Name:BARONE
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3466 N HARBOR CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-5713
Mailing Address - Country:US
Mailing Address - Phone:321-434-1981
Mailing Address - Fax:321-951-7408
Practice Address - Street 1:603 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2107
Practice Address - Country:US
Practice Address - Phone:321-268-5008
Practice Address - Fax:321-607-6690
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL3188122363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302284G00Medicaid
S62812Medicare UPIN
FLE1190XMedicare ID - Type Unspecified