Provider Demographics
NPI:1003360058
Name:MUSOKO, FITZWILLIAM ESELE (APRN)
Entity Type:Individual
Prefix:
First Name:FITZWILLIAM
Middle Name:ESELE
Last Name:MUSOKO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 BEARDSLEY CIR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2670
Mailing Address - Country:US
Mailing Address - Phone:813-420-5470
Mailing Address - Fax:
Practice Address - Street 1:1024 W OWENS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2520
Practice Address - Country:US
Practice Address - Phone:813-420-5470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9342679363L00000X, 363LF0000X
NV827678363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAJW4LOtherBCBS
APRN9342679OtherFL LICENSE
FL018432500Medicaid
NVAPRN827678OtherNV APRN LICENSE
NVAPRN827678OtherNV APRN LICENSE