Healthcare Provider Details

I. General information

NPI: 1891606901
Provider Name (Legal Business Name): MITRA POURMAKHDOOMI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8237 SW 52ND LANE RD
OCALA FL
34481-6458
US

IV. Provider business mailing address

8237 SW 52ND LANE RD
OCALA FL
34481-6458
US

V. Phone/Fax

Practice location:
  • Phone: 407-535-0654
  • Fax:
Mailing address:
  • Phone: 407-535-0654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberF08260526
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: