Healthcare Provider Details

I. General information

NPI: 1265034763
Provider Name (Legal Business Name): MICHAEL ERIC MUIR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 W MONROE ST STE 200
JACKSONVILLE FL
32204-1177
US

IV. Provider business mailing address

915 W MONROE ST STE 200
JACKSONVILLE FL
32204-1177
US

V. Phone/Fax

Practice location:
  • Phone: 904-384-2240
  • Fax: 904-486-2314
Mailing address:
  • Phone: 904-384-2254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11010110
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN9342819
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11010110
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: