Provider Demographics
NPI:1740631639
Name:PAUL, MINI (FNP-BC)
Entity type:Individual
Prefix:
First Name:MINI
Middle Name:
Last Name:PAUL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 RED PEPPER LOOP
Mailing Address - Street 2:
Mailing Address - City:CHULUOTA
Mailing Address - State:FL
Mailing Address - Zip Code:32766-6010
Mailing Address - Country:US
Mailing Address - Phone:407-227-9756
Mailing Address - Fax:
Practice Address - Street 1:8021 INTERNATIONAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-9312
Practice Address - Country:US
Practice Address - Phone:407-352-7071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9404339363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily