Schupp, Mary Kathleen

Schupp, Mary Kathleen is an individual health care provider with primary practice located at 100 Whetstone Pl Ste 208 , St Augustine FL 32086-5775. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Schupp, Mary Kathleen can be contacted via phone (904) 447-7377.

Contact Information

Primary practice address
100 Whetstone Pl Ste 208 St Augustine FL 32086-5775
Phone: (904) 447-7377
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X ARNP1104662 Florida

Profile Details

NPI number 1851445860
LBN Legal business name Schupp, Mary Kathleen
Credentials ARNP
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 23rd, 2007
Last updated May 11th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1851445860 NPPES
Florida MEDICAID 020952200

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