Healthcare Provider Details

I. General information

NPI: 1124936398
Provider Name (Legal Business Name): TINA MUMLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 EL CAMINO REAL
LADY LAKE FL
32159-0041
US

IV. Provider business mailing address

2115 SANDRIDGE CIR
EUSTIS FL
32726-4487
US

V. Phone/Fax

Practice location:
  • Phone: 352-751-8000
  • Fax:
Mailing address:
  • Phone: 352-431-8312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS71300
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: