Individual
MARY ANNE FITZGERALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
815 N BROADWAY AVE, TYLER, TX 75702-4507
(903) 535-0023
(903) 535-0052
Mailing address
PO BOX 2039, TYLER, TX 75710-2039
(903) 535-0023
(903) 535-0052
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
218756
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
218756
NURSE PRACTITIONER LICENS
TX
Enumeration date
08/19/2006
Last updated
07/08/2007
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