Healthcare Provider Details

I. General information

NPI: 1164504262
Provider Name (Legal Business Name): VIRGINIA DIANE MUSSELWHITE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18450 US HIGHWAY 441
MOUNT DORA FL
32757-6707
US

IV. Provider business mailing address

2103 STONEBRIDGE WAY
CLERMONT FL
34711-6915
US

V. Phone/Fax

Practice location:
  • Phone: 352-383-4966
  • Fax: 352-383-2001
Mailing address:
  • Phone: 352-243-2725
  • Fax: 352-383-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberARNP525252
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: