Healthcare Provider Details

I. General information

NPI: 1265167217
Provider Name (Legal Business Name): CARMEN MOUZOURAKIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2022
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8905 BRYAN DAIRY RD
LARGO FL
33777-1102
US

IV. Provider business mailing address

8905 BRYAN DAIRY RD
LARGO FL
33777-1102
US

V. Phone/Fax

Practice location:
  • Phone: 727-393-7542
  • Fax: 727-319-6090
Mailing address:
  • Phone: 727-393-7542
  • Fax: 727-319-6090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11020520
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: