Individual
MARY ANN BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1334 DALLAS AVE, WINTER PARK, FL 32789-3641
(407) 647-5521
Mailing address
1334 DALLAS AVE, WINTER PARK, FL 32789-3641
(407) 647-5521
Taxonomy
Speciality
Code
Description
License number
State
163WC1600X
Continuing Education/Staff Development Registered Nurse
Primary
RN743762
FL
Other
Enumeration date
12/20/2018
Last updated
12/20/2018
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