Provider Demographics
NPI:1316051550
Name:NALL, MARY VIRGINIA (GINI) (ARNP-C)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:VIRGINIA (GINI)
Last Name:NALL
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 W MOWRY DR
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-5746
Mailing Address - Country:US
Mailing Address - Phone:305-248-4334
Mailing Address - Fax:
Practice Address - Street 1:810 W MOWRY DR
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-5746
Practice Address - Country:US
Practice Address - Phone:305-248-4334
Practice Address - Fax:305-245-1161
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1472592363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS76191Medicare UPIN
FLE2272WMedicare ID - Type Unspecified