Active NPI
Mallory Harrington
- Family Nurse Practitioner
- Port St Lucie, FL
National Provider Identifier
1811645575
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 11018475
- Practice address
- 1556 SW Crater Ave
Port St Lucie, FL 34953-6144 - Phone
- (585) 738-2563
- NPI assigned
- Mar 12, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 11018475 | FL | Primary |
Addresses
Primary practice location
1556 SW Crater Ave
Port St Lucie, FL 34953-6144
Mailing address
571 Manatee Bay Dr
Boynton Beach, FL 33435-2801
Phone (585) 738-2563
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250402000700 | FL | Practitioner - Nurse Practitioner | 2466975206 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11018475 | FL | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1647043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712534400000",
"number": "1811645575",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "571 MANATEE BAY DR",
"city": "BOYNTON BEACH",
"state": "FL",
"postal_code": "334352801",
"telephone_number": "585-738-2563"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1556 SW CRATER AVE",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349536144",
"telephone_number": "585-738-2563"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRINGTON",
"first_name": "MALLORY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-03-12",
"last_updated": "2024-04-08",
"certification_date": "2024-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "FL",
"license": "11018475",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port St Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.