Provider Demographics
NPI:1144756172
Name:JOANNA MULDER NP INC
Entity Type:Organization
Organization Name:JOANNA MULDER NP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:T
Authorized Official - Last Name:MULDER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:813-376-0712
Mailing Address - Street 1:2553 MASON OAKS DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-6498
Mailing Address - Country:US
Mailing Address - Phone:813-940-6046
Mailing Address - Fax:866-451-4607
Practice Address - Street 1:2553 MASON OAKS DR
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-6498
Practice Address - Country:US
Practice Address - Phone:813-376-0712
Practice Address - Fax:813-315-6009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP831452363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty