MARY PETERSON ADMINISTRATOR NPI 1063221646

NPI Information

  • NPI: 1063221646
  • Provider Name: MARY PETERSON, ADMINISTRATOR
  • Classification: Assisted Living Facility - 310400000X
  • Entity Type: Individual
  • Address: 1622 SILVER ST
    JACKSONVILLE, FL
    ZIP 32206
  • Phone: (904) 356-3022

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NPI Details

Mary Peterson, ADMINISTRATOR is an assisted living facility in Jacksonville, FL. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. Mary Peterson, ADMINISTRATOR NPI is 1063221646. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1622 SILVER ST
JACKSONVILLE, FL
ZIP 32206-446
Phone: (904) 356-3022
Fax: (904) 350-9165

The enumeration date for this NPI number is 1/7/2025 and was last updated on 1/7/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1310400000XAssisted Living Facility8638FLORIDAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

NPI Synchronization or Removal

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