Provider Demographics
NPI:1972897403
Name:MUBARAK, ADRIENNE DENISE (APN)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:DENISE
Last Name:MUBARAK
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 EDGELY LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-6353
Mailing Address - Country:US
Mailing Address - Phone:773-457-9000
Mailing Address - Fax:
Practice Address - Street 1:30 EDGELY LN
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-6353
Practice Address - Country:US
Practice Address - Phone:773-457-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9378786363LG0600X
IL209.008670363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN9378786OtherFL RN LICENSE
FLAPRN9378786OtherFL APRN LICENSE