Provider Demographics
NPI:1184516254
Name:OBAED, MARY NICOLE (DNP, APRN-BC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:NICOLE
Last Name:OBAED
Suffix:
Gender:F
Credentials:DNP, APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 E DORCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-3260
Mailing Address - Country:US
Mailing Address - Phone:904-887-9894
Mailing Address - Fax:
Practice Address - Street 1:848 E DORCHESTER DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259-3260
Practice Address - Country:US
Practice Address - Phone:904-887-9894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11040245363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily