Provider Demographics
NPI:1487838645
Name:RAY, MIOK (NP)
Entity Type:Individual
Prefix:
First Name:MIOK
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MIOK
Other - Middle Name:
Other - Last Name:IM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4321 N MACDILL AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6390
Mailing Address - Country:US
Mailing Address - Phone:813-873-7615
Mailing Address - Fax:813-443-8134
Practice Address - Street 1:4321 N MACDILL AVE STE 203
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6390
Practice Address - Country:US
Practice Address - Phone:813-873-7615
Practice Address - Fax:813-443-8134
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9306708363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002429300Medicaid
FLDH821YMedicare PIN