Provider Demographics
NPI:1598139198
Name:MINT PHYSICIAN STAFFING
Entity Type:Organization
Organization Name:MINT PHYSICIAN STAFFING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:SAMIAT
Authorized Official - Middle Name:O
Authorized Official - Last Name:TELUFUSI
Authorized Official - Suffix:
Authorized Official - Credentials:RN-BSN,FNP-C
Authorized Official - Phone:281-686-8260
Mailing Address - Street 1:6335 LYNKAT LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-1817
Mailing Address - Country:US
Mailing Address - Phone:281-686-8260
Mailing Address - Fax:
Practice Address - Street 1:6335 LYNKAT LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-1817
Practice Address - Country:US
Practice Address - Phone:281-686-8260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0815232261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care