MARYELLEN E GREENE (NPI# 1669521001) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669521001 |
| Entity Type | Individual |
| Full Name | MARYELLEN E GREENE |
| Credential | PA-C |
| Practice Address |
1990 N Prospect Ave Lecanto FL 34461-9792 |
| Practice Telephone | 3525276888 |
| Practice Fax Number | 3525278818 |
| Mailing Telephone | 3525276888 |
| Mailing Fax Number | 3525278818 |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2012-03-22 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA9104960 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1990 N PROSPECT AVE |
| City | LECANTO |
| State | FL |
| Zip Code | 34461-9792 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255397501 | Angela White Kelley | Physician Assistant | 1990 N Prospect Ave, Lecanto, FL 34461-9792 | 2006-04-25 |
| 1487273256 | Brittany Alce | Physician Assistant | 1990 N Prospect Ave, Lecanto, FL 34461-9792 | 2020-04-13 |
| 1174156855 | Ann Marie O'shall | Nurse Practitioner | 1990 N Prospect Ave, Lecanto, FL 34461-9792 | 2020-02-20 |
| 1518516590 | Hollie Taina Marie Saylor | Physician Assistant | 1990 N Prospect Ave, Lecanto, FL 34461-9792 | 2019-09-11 |
| 1689159709 | Sarah Elizabeth Richter | Internal Medicine | 1990 N Prospect Ave, Lecanto, FL 34461-9792 | 2018-09-25 |
| 1871073122 | Sicknwell LLC | Clinic/Center | 1990 N Prospect Ave, Lecanto, FL 34461-9792 | 2018-08-16 |
| 1023500535 | My Home Sleep Testing LLC | Family Medicine | 1990 N Prospect Ave, Lecanto, FL 34461-9792 | 2018-05-31 |
| 1346744729 | Allison Lavon Ledsome | Nurse Practitioner | 1990 N Prospect Ave, Lecanto, FL 34461-9792 | 2018-03-21 |
| 1174033435 | Charles F. Brinegar Jr. | Nurse Practitioner | 1990 N Prospect Ave, Lecanto, FL 34461-9792 | 2017-10-01 |
| 1679098305 | Alexis Bushman | Physician Assistant | 1990 N Prospect Ave, Lecanto, FL 34461-9792 | 2017-08-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891261160 | Shekinah Barfield | Physician Assistant | Pediatric and Internal Medicine Specialist Inc, 1990 N Prospect Ave, Lecanto, FL 34461 | 2018-10-15 |
| 1699240887 | Medical Risk Solutions | Family Medicine | 2804 W. Marc Knighton Court Key #10, Lecanto, FL 34461 | 2018-10-04 |
| 1851848097 | Pedim Outreach and Specialty Clinic LLC | Family Medicine | 1982 N Prospect Ave, Lecanto, FL 34461 | 2016-09-06 |
| 1265776579 | Wal-mart Stores East Lp | Technician/Technologist | 1936 N. Lecanto Hwy, Lecanto, FL 34461 | 2012-11-27 |
| 1922306109 | Pediatric and Internal Medicine Specialists, Pa | Clinic/Center | 1980 North Prospect Avenue, Lecanto, FL 34461 | 2011-03-11 |
| 1942459078 | Crq Enterprises LLC | Home Health | 4214 W Gulf To Lake Hwy, Lecanto, FL 34461 | 2008-09-12 |
| 1548418064 | Thomas Tybeck | Counselor | 324 S Kensington Ave Ste 328, Lecanto, FL 34461 | 2008-09-09 |
| 1356533566 | Amanda Nicole Coppedge | Optometrist | 240 N. Lecanto Hwy., Lecanto, FL 34461 | 2007-08-11 |
| 1679779185 | Brashears Vital Care Corp | Pharmacy | 471 N Dacie Pt, Lecanto, FL 34461 | 2007-06-22 |
| 1285751099 | Interim Healthcare Private Services, Inc. | Home Health | 581 E. Gulf To Lake Highway, Village West Plaza, Lecanto, FL 34461 | 2007-03-25 |
| Find all providers in zip 34461 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427579432 | Mujiba Sanjareen Ansari | Physician Assistant | 3248 W Pebble Beach Ct, Lecanto, FL 34461-7774 | 2017-06-29 |
| 1255397501 | Angela White Kelley | Physician Assistant | 1990 N Prospect Ave, Lecanto, FL 34461-9792 | 2006-04-25 |
| 1821534926 | Gliset Norman | Physician Assistant | 1990 N Prospect Ave, Lecanto, FL 34461-9792 | 2017-01-12 |
| 1750790150 | Cristina Marie Dorta | Physician Assistant | 1990 N Prospect Ave, Lecanto, FL 34461-9792 | 2014-08-11 |
| 1316119514 | Tamra Renae Assumpcao | Physician Assistant | 1990 N Prospect Ave, Lecanto, FL 34461-9792 | 2008-03-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255931325 | Jonathan Thomas Nusbaum | Physician Assistant | 26160 Angelica Rd, Punta Gorda, FL 33955-1419 | 2020-10-28 |
| 1235738659 | Kevin Marcus Luks | Physician Assistant | 10701 Santa Fe Dr, Hollywood, FL 33026-4955 | 2020-10-19 |
| 1245839521 | Stephanie Clay | Physician Assistant | 3455 Rose Mallow Loop, Oviedo, FL 32766-6648 | 2020-10-19 |
| 1104423755 | Lou Joseph Schneggenburger | Physician Assistant | 10115 Forest Hill Blvd Ste 100, Wellington, FL 33414-6178 | 2020-10-07 |
| 1235744582 | Stephanie Graham | Physician Assistant | 1053 Bernice Rd, Rockledge, FL 32955-2201 | 2020-09-14 |
| 1790399483 | Shyla Imani Kissoon | Physician Assistant | 4830 Nw 7th St, Plantation, FL 33317-1410 | 2020-09-01 |
| 1770193500 | My Physician Online | Physician Assistant | 9540 Nw 23rd St, Coral Springs, FL 33065-4974 | 2020-08-06 |
| 1225647977 | Robert Drew Singleton | Physician Assistant | 17501 Biscayne Blvd Ste 460, Aventura, FL 33160-4806 | 2020-07-29 |
| 1750990974 | Andrea K Webber | Physician Assistant | 8119 Sw State Rd 200, Ocala, FL 34481-3448 | 2020-07-23 |
| 1851919526 | Kyra Panni | Physician Assistant | 3857 Hartwood Ln, Jacksonville, FL 32216-1486 | 2020-07-09 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.