Provider Demographics
NPI:1538996913
Name:AIRHEART, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:AIRHEART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 E ADAMS ST STE 210
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-3356
Mailing Address - Country:US
Mailing Address - Phone:904-265-1777
Mailing Address - Fax:
Practice Address - Street 1:221 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-4907
Practice Address - Country:US
Practice Address - Phone:904-355-1436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator