Provider Demographics
NPI:1053530030
Name:BRALLIER, MARY DEBORAH (ARNP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:DEBORAH
Last Name:BRALLIER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:263 SW ACE LN
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-1652
Mailing Address - Country:US
Mailing Address - Phone:386-623-2050
Mailing Address - Fax:386-719-2436
Practice Address - Street 1:7019 NW 11TH PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3145
Practice Address - Country:US
Practice Address - Phone:352-376-1611
Practice Address - Fax:352-379-7473
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 0935112363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily