Basic Information
Provider Information
NPI: 1891774105
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BOYER
FirstName: MARYLEE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4881 NW 8TH AVE
Address2: SUITE 2
City: GAINESVILLE
State: FL
PostalCode: 326054582
CountryCode: US
TelephoneNumber: 3523736338
FaxNumber: 3523736144
Practice Location
Address1: 3305 SW 34TH CIR
Address2: SUITE 101
City: OCALA
State: FL
PostalCode: 344746616
CountryCode: US
TelephoneNumber: 3527323110
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/13/2006
LastUpdateDate: 12/09/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XARNP827062FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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