Provider Demographics
NPI:1386639151
Name:MULDER, JOANNA T (ARNP)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:T
Last Name:MULDER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:813-376-0712
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:813-657-8290
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN831452363L00000X
FL831452363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL033729300Medicaid
FLS63726Medicare UPIN
FLY3170ZMedicare PIN