Individual
MARY ETHRIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16 CEDAR POINT DR, PALM COAST, FL 32164-4265
(850) 557-3016
Mailing address
16 CEDAR POINT DR, PALM COAST, FL 32164-4265
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
9221828
FL
Other
Enumeration date
06/13/2022
Last updated
06/13/2022
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