Healthcare Provider Details

I. General information

NPI: 1083641096
Provider Name (Legal Business Name): MARK P MULLER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PINELLAS ST
CLEARWATER FL
33756-3804
US

IV. Provider business mailing address

PO BOX 850001
ORLANDO FL
32885-0001
US

V. Phone/Fax

Practice location:
  • Phone: 727-461-8537
  • Fax:
Mailing address:
  • Phone: 904-482-1070
  • Fax: 904-482-1077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9101634
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: