Provider Demographics
NPI:1700693975
Name:ST MARY, AUBREY ANNA
Entity type:Individual
Prefix:MRS
First Name:AUBREY
Middle Name:ANNA
Last Name:ST MARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AUBREY
Other - Middle Name:ANNA
Other - Last Name:FIORELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:824 GREENLEAF CIR
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-3215
Mailing Address - Country:US
Mailing Address - Phone:772-584-2727
Mailing Address - Fax:
Practice Address - Street 1:824 GREENLEAF CIR
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-3215
Practice Address - Country:US
Practice Address - Phone:772-584-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11028103363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner