Individual provider Active NPI

Ann Mahan, A.P.N.

  • Women's Health Nurse Practitioner
  • Boca Raton, FL
National Provider Identifier
1033317979
Registry record updated Aug 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
26NNO8170200 Issued in NJ
Practice address
777 Glades Rd RM 240
Boca Raton, FL 33431-6424
Phone
(561) 297-3512
NPI assigned
Jul 3, 2007
Last updated
Aug 30, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X 26NNO8170200 NJ Primary

Addresses

Primary practice location

777 Glades Rd RM 240
Boca Raton, FL 33431-6424

Mailing address

15 Valley Rd
Nutley, NJ 07110-2224
Phone (973) 667-7774

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221025003066 FL Practitioner - Nurse Practitioner 4183090681 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
26NNO8170200NJMDWomen's Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Prestige Obstetrics and Gynecology Associates LLC CurrentSince Aug 14, 2025 Accepting new patients
Prestige Recovery and Suboxone Clinic LLC CurrentSince May 31, 2025 Accepting new patients
Prestige Clinicians LLC CurrentSince May 31, 2025 Accepting new patients
Vitalmd Group Holding LLC CurrentSince Sep 2, 2022 Accepting new patients
Florida Atlantic University PastSince Sep 1, 2019 Accepting new patients
Florida Atlantic University Past Accepting new patients
Medm LLC PastSince May 1, 2024 Accepting new patients

Locations

3800 W Broward Blvd
Ste 101
Ft Lauderdale, FL 33312
Phone (954) 440-0983

406 E Vine St
Rm C
Kissimmee, FL 34744
Phone 9542710291201

3225 Aviation Ave
Ste 700
Miami, FL 33133
Phone (305) 273-4641

4513 NW 31st Ave
Oakland Park, FL 33309
Phone (954) 496-2599

7401 N University Dr
Ste 101
Tamarac, FL 33321
Phone (954) 722-2002

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/23897/brand/1/csg/1/fhir/r4

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1183420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567123200000",
    "number": "1033317979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 VALLEY RD",
            "city": "NUTLEY",
            "state": "NJ",
            "postal_code": "071102224",
            "telephone_number": "973-667-7774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 GLADES RD RM 240",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334316424",
            "telephone_number": "561-297-3512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHAN",
        "first_name": "ANN",
        "credential": "A.P.N.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-03",
        "last_updated": "2019-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "NJ",
            "license": "26NNO8170200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boca Raton, FL

Sources for this page

Verify at the official NPI Registry.