Healthcare Provider Details

I. General information

NPI: 1609405588
Provider Name (Legal Business Name): AMINA MALIKA PRATT-EUGENE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 REW CIR STE 200
OCOEE FL
34761-2967
US

IV. Provider business mailing address

PO BOX 47223
TAMPA FL
33646-0111
US

V. Phone/Fax

Practice location:
  • Phone: 888-373-0013
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20233
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: