Provider Demographics
NPI:1649071051
Name:MISIC, JOVANA (APRN)
Entity type:Individual
Prefix:
First Name:JOVANA
Middle Name:
Last Name:MISIC
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2814 W DR MARTIN LUTHER KING JR BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6374
Mailing Address - Country:US
Mailing Address - Phone:813-534-0009
Mailing Address - Fax:
Practice Address - Street 1:2814 W DR MARTIN LUTHER KING JR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6374
Practice Address - Country:US
Practice Address - Phone:813-534-0009
Practice Address - Fax:833-921-2150
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11038164363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health