Provider Demographics
NPI:1265521124
Name:MURRAY, MUTESSA (NP)
Entity type:Individual
Prefix:
First Name:MUTESSA
Middle Name:
Last Name:MURRAY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15955 SW 96TH ST
Mailing Address - Street 2:STE 301
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1273
Mailing Address - Country:US
Mailing Address - Phone:305-275-8200
Mailing Address - Fax:
Practice Address - Street 1:16621 SW 141ST AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-2088
Practice Address - Country:US
Practice Address - Phone:305-235-7963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2628022363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily