Provider Demographics
NPI:1598389165
Name:MYRICK, MUKIA
Entity Type:Individual
Prefix:
First Name:MUKIA
Middle Name:
Last Name:MYRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 ALOMA AVE STE 255
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2541
Mailing Address - Country:US
Mailing Address - Phone:407-765-8966
Mailing Address - Fax:
Practice Address - Street 1:630 CORAL GLEN LOOP APT 101
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-1791
Practice Address - Country:US
Practice Address - Phone:407-765-8966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator