Provider Demographics
NPI:1801831698
Name:MOUSSA, MALINDA M (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MALINDA
Middle Name:M
Last Name:MOUSSA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:MALINDA
Other - Middle Name:M
Other - Last Name:SUBHAKUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 25317
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-5317
Mailing Address - Country:US
Mailing Address - Phone:813-286-0033
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:1361 13TH AVE S STE 110&190
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3233
Practice Address - Country:US
Practice Address - Phone:904-247-5514
Practice Address - Fax:904-247-3363
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN2547972363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002226500Medicaid
FLCU058ZMedicare PIN