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: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11174 MINNETTA CT
JACKSONVILLE FL
32256-5887
US

IV. Provider business mailing address

11174 MINNETTA CT
JACKSONVILLE FL
32256-5887
US

V. Phone/Fax

Practice location:
  • Phone: 904-472-1355
  • Fax:
Mailing address:
  • Phone: 904-472-1355
  • 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: