Provider Demographics
NPI:1780698746
Name:MULLEAVY, PATRICK J (CRNA)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:MULLEAVY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:109 ROYAL PARK DR APT 4H
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-5873
Mailing Address - Country:US
Mailing Address - Phone:954-543-4372
Mailing Address - Fax:
Practice Address - Street 1:7154 N UNIVERSITY DR # 316
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2916
Practice Address - Country:US
Practice Address - Phone:954-720-3188
Practice Address - Fax:954-586-2589
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2008072207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306734300Medicaid
FL306734300Medicaid