Healthcare Provider Details

I. General information

NPI: 1497579783
Provider Name (Legal Business Name): CHAYA MUSHKA MINKOWICZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2443 E 4TH ST
TUCSON AZ
85719-5122
US

IV. Provider business mailing address

1011 SHADDELEE LN E
FORT MYERS FL
33919-2619
US

V. Phone/Fax

Practice location:
  • Phone: 239-281-3142
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number9622412
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: