Individual provider Active NPI

Mary Elizabeth Van Vliet, APRN

  • Nurse Practitioner
  • Tallahassee, FL
National Provider Identifier
1245747385
Registry record updated Oct 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
ARNP9335972 Issued in FL
Practice address
1300 Medical Dr
Tallahassee, FL 32308-4646
Phone
(850) 216-0100
NPI assigned
Jan 10, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X ARNP9335972 FL Primary

Addresses

Primary practice location

1300 Medical Dr
Tallahassee, FL 32308-4646

Mailing address

1300 Medical Dr
Tallahassee, FL 32308-4646
Phone (850) 216-0100

Other identifiers 2

IdentifierTypeStateIssuer
060754100MedicaidFL
100847000MedicaidFL

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
I20190207002847 FL Practitioner - Nurse Practitioner 3375805567 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tallahassee Memorial Healthcare IncGroup PAC ID 6103724778, 498 clinicians

Practice addresses (Care Compare)

1300 Medical Dr
Tallahassee, FL 32308-4646
Phone (850) 216-0100

Hospital & facility affiliations

  • Tallahassee Memorial Healthcare Hospital, Tallahassee, FL, CCN 100135

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ARNP9335972FLMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Tallahassee Memorial Healthcare Inc CurrentSince Sep 12, 2024 Accepting new patients
North Florida Nephrology Associates CurrentSince Oct 31, 2018 Accepting new patients
Tallahassee Memorial Healthcare Inc CurrentSince Sep 12, 2024 Accepting new patients
Tallahassee Memorial Healthcare Inc Current Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients

Locations

15 Council Moore Rd
Crawfordville, FL 32327
Phone (850) 926-7105

1401 Centerville Rd
Ste 400
Tallahassee, FL 32308
Phone (850) 431-3360

1300 Miccosukee Rd
Tallahassee, FL 32308
Phone (850) 431-1155

1300 Medical Dr
Tallahassee, FL 32308
Phone (850) 216-0190

2617 Mitcham Dr
Ste 102
Tallahassee, FL 32308
Phone (850) 878-1171

1609 Physicians Dr
Tallahassee, FL 32308
Phone (850) 431-4243

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.72257
  • Direct secure messaging: clinical@nfna.directbygreenway.com
  • Direct secure messaging: mvanvliet21740@tallahasseememorial.direct-ci.com

Organizations & group practices 5

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

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1515542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730073600000",
    "number": "1245747385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 MEDICAL DR",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084646",
            "telephone_number": "850-216-0100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 MEDICAL DR",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084646",
            "telephone_number": "850-216-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN VLIET",
        "first_name": "MARY",
        "middle_name": "ELIZABETH",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-10",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "ARNP9335972",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060754100",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100847000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

Verify at the official NPI Registry.