Provider Demographics
NPI:1598361925
Name:MUTZ, ERICKA (NP-C, APRN)
Entity Type:Individual
Prefix:
First Name:ERICKA
Middle Name:
Last Name:MUTZ
Suffix:
Gender:F
Credentials:NP-C, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5440 S MACDILL AVE APT 1L
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-4414
Mailing Address - Country:US
Mailing Address - Phone:813-774-3507
Mailing Address - Fax:
Practice Address - Street 1:2111 W SWANN AVE STE 103
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2478
Practice Address - Country:US
Practice Address - Phone:813-774-3507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014786363L00000X
FL11007665363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner