Provider Demographics
NPI:1457649030
Name:MUSE, PATRICE M (ARNP)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:M
Last Name:MUSE
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 1:55 W GORE ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1140
Mailing Address - Country:US
Mailing Address - Phone:321-841-5469
Mailing Address - Fax:321-841-7470
Practice Address - Street 1:55 W GORE ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1140
Practice Address - Country:US
Practice Address - Phone:321-841-5469
Practice Address - Fax:321-841-7470
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2521942363LF0000X
FLAPRN2521942363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003909800Medicaid
FLFF623ZMedicare PIN