Basic Information
| Provider Information | |||||||||
| NPI: | 1043607161 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOSCIA | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | LOUIS | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | ARNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LYONS | ||||||||
| OtherFirstName: | MARY | ||||||||
| OtherMiddleName: | SOSCIA | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5426 BAY CENTER DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336093444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8135696500 | ||||||||
| FaxNumber: | 8138644030 | ||||||||
| Practice Location | |||||||||
| Address1: | 3945 CLARK RD | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342332364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9419232500 | ||||||||
| FaxNumber: | 9419232520 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2015 | ||||||||
| LastUpdateDate: | 04/17/2015 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP9204002 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.