Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | ARNP9289684 | FL |
NPI | 1013351907 |
---|---|
Provider Name | Joumana Mullah |
First Address | Bay Pines, FL 33744-8200 |
Second Address | Bay Pines, FL 33744-8200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2013 |
Last Update Date | 22/04/2013 |