Provider Demographics
NPI:1952647224
Name:MAZUR, PAUL M (CNP)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:MAZUR
Suffix:
Gender:M
Credentials:CNP
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Mailing Address - Street 1:5355 RED BUG LAKE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4909
Mailing Address - Country:US
Mailing Address - Phone:321-304-3300
Mailing Address - Fax:321-304-3287
Practice Address - Street 1:1051 W US ROUTE 6
Practice Address - Street 2:SUITE 100
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-4200
Practice Address - Country:US
Practice Address - Phone:815-942-4875
Practice Address - Fax:815-942-5046
Is Sole Proprietor?:No
Enumeration Date:2012-12-14
Last Update Date:2016-07-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL041420668163W00000X
IL209011601363L00000X
FLARNP9247331363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner