Individual
MARY D REDFEARN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3229 BEAR RUN BLVD BLDG B, ORANGE PARK, FL 32065-7334
(904) 272-3177
Mailing address
PO BOX 578, GREEN COVE SPRINGS, FL 32043-0578
(904) 272-3177
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
ARNP485802
FL
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
ARNP485802
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
034577600
—
FL
Enumeration date
11/17/2006
Last updated
12/21/2012
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