Provider Demographics
NPI:1265034763
Name:MUIR, MICHAEL ERIC
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ERIC
Last Name:MUIR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4681 PLANTATION OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-3652
Mailing Address - Country:US
Mailing Address - Phone:904-864-0907
Mailing Address - Fax:
Practice Address - Street 1:4681 PLANTATION OAKS BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-3652
Practice Address - Country:US
Practice Address - Phone:904-864-0907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9342819163WG0000X
FLAPRN11010110363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice