Provider Demographics
NPI:1588892178
Name:CARRIGAN, MARY ELSIELYNN (ARNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELSIELYNN
Last Name:CARRIGAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ELSIE
Other - Middle Name:
Other - Last Name:CARRIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP - PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3199
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:6271 SAINT AUGUSTINE RD
Practice Address - Street 2:UFJAX - DEPT. OF PEDIATRICES
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2523
Practice Address - Country:US
Practice Address - Phone:904-633-0926
Practice Address - Fax:904-633-0461
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2508052363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA591290544BMedicaid
GA591290544AMedicaid
FL0012787-00Medicaid
FLCG975ZMedicare PIN