Provider Demographics
NPI:1083179030
Name:SEAGULL, MYLINH (NP)
Entity Type:Individual
Prefix:
First Name:MYLINH
Middle Name:
Last Name:SEAGULL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 ARCHER DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7528
Mailing Address - Country:US
Mailing Address - Phone:817-381-9858
Mailing Address - Fax:
Practice Address - Street 1:10005 LEAFWOOD DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-5113
Practice Address - Country:US
Practice Address - Phone:561-350-1701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61225770363L00000X
FLRN3402842363L00000X, 363LF0000X
TX143903363L00000X
AK186260363LP0808X
FL11001865363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily