Provider Demographics
NPI:1215422068
Name:CISCO, MARY CATHERINE (DNP, MBA, MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:CISCO
Suffix:
Gender:F
Credentials:DNP, MBA, MSN, FNP-C
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CATHERINE
Other - Last Name:CISCO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, MBA, MSN, FNPC
Mailing Address - Street 1:110 S WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3546
Mailing Address - Country:US
Mailing Address - Phone:407-905-8827
Mailing Address - Fax:321-221-9454
Practice Address - Street 1:225 N 1ST ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5150
Practice Address - Country:US
Practice Address - Phone:407-905-8827
Practice Address - Fax:352-360-2389
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9404063363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily