Provider Demographics
NPI:1932408408
Name:MCMULLEN, ERICA MARGARET (APRN)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:MARGARET
Last Name:MCMULLEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:954-493-6496
Mailing Address - Fax:954-493-6726
Practice Address - Street 1:6181 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-2227
Practice Address - Country:US
Practice Address - Phone:954-493-6496
Practice Address - Fax:954-493-6726
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9294640363LF0000X
FL9294640363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023804400Medicaid