Individual
MRS. MARY JOHNSON LANCTOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
801 6TH ST S, ST PETERSBURG, FL 33701-4816
(727) 767-8281
Mailing address
1499 54TH AVE NE, ST PETERSBURG, FL 33703-3226
(727) 767-8281
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
9197354
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
306768800
—
FL
Enumeration date
07/11/2007
Last updated
09/18/2008
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