Healthcare Provider Details

I. General information

NPI: 1174536411
Provider Name (Legal Business Name): MARCIA RESING MULLIS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 BAY PINES BOULEVARD
BAY PINES FL
33744
US

IV. Provider business mailing address

10008 LINDEN PLACE DR
SEMINOLE FL
33776-1601
US

V. Phone/Fax

Practice location:
  • Phone: 727-398-6661
  • Fax:
Mailing address:
  • Phone: 727-596-9055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1173022
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: