Provider Demographics
NPI:1366724239
Name:MYRTHIL, MARY-ANN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MARY-ANN
Middle Name:
Last Name:MYRTHIL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:MARY-ANN
Other - Middle Name:
Other - Last Name:LIMONTAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1990 LARKIN AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5827
Mailing Address - Country:US
Mailing Address - Phone:847-289-5727
Mailing Address - Fax:
Practice Address - Street 1:7800 LIBERTY LN
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-4743
Practice Address - Country:US
Practice Address - Phone:347-733-9787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9112917363AM0700X
NY015125363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical