Provider Demographics
NPI:1457149221
Name:CALITRI, MARY BROOKE
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:BROOKE
Last Name:CALITRI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3183 DESOTO DR
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33983-3412
Mailing Address - Country:US
Mailing Address - Phone:941-661-3906
Mailing Address - Fax:
Practice Address - Street 1:3183 DESOTO DR
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33983-3412
Practice Address - Country:US
Practice Address - Phone:941-661-3906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant