Provider Demographics
NPI:1932496783
Name:MOBILE MEDICAL ASSOCIATES, P.L.
Entity Type:Organization
Organization Name:MOBILE MEDICAL ASSOCIATES, P.L.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:GRISSMAN
Authorized Official - Last Name:MCCUEN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, DNP
Authorized Official - Phone:772-221-7620
Mailing Address - Street 1:4181 SW HIGH MEADOWS AVE
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-3725
Mailing Address - Country:US
Mailing Address - Phone:772-221-7620
Mailing Address - Fax:772-221-9903
Practice Address - Street 1:4181 SW HIGH MEADOWS AVE
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-3725
Practice Address - Country:US
Practice Address - Phone:772-221-7620
Practice Address - Fax:772-221-9903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-30
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty