Healthcare Provider Details

I. General information

NPI: 1831954346
Provider Name (Legal Business Name): YOKO MIZUSHIMA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N RIDGEWOOD AVE
EDGEWATER FL
32132-1617
US

IV. Provider business mailing address

315 N RIDGEWOOD AVE
EDGEWATER FL
32132-1617
US

V. Phone/Fax

Practice location:
  • Phone: 386-427-8403
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11023234
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: