Provider Demographics
NPI:1962235358
Name:MUSTAFA, NAGLA (FNP-C)
Entity type:Individual
Prefix:
First Name:NAGLA
Middle Name:
Last Name:MUSTAFA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9086 FELLOWS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-6354
Mailing Address - Country:US
Mailing Address - Phone:313-443-0305
Mailing Address - Fax:313-262-6027
Practice Address - Street 1:3301 HOLBROOK ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3519
Practice Address - Country:US
Practice Address - Phone:313-872-5555
Practice Address - Fax:313-262-6027
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704402108363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner