Healthcare Provider Details

I. General information

NPI: 1538003140
Provider Name (Legal Business Name): PHILLIP A MUNOZ RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 2ND ST E
BRADENTON FL
34208-1000
US

IV. Provider business mailing address

7330 MERLOT SIENNA AVE
GIBSONTON FL
33534-3946
US

V. Phone/Fax

Practice location:
  • Phone: 269-924-7090
  • Fax:
Mailing address:
  • Phone: 269-924-7090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN9485677
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: