Healthcare Provider Details

I. General information

NPI: 1063812535
Provider Name (Legal Business Name): WILLIAM MIZELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 09/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4402 HAYLOCK DR
ORLANDO FL
32807-1010
US

IV. Provider business mailing address

4402 HAYLOCK DR
ORLANDO FL
32807-1010
US

V. Phone/Fax

Practice location:
  • Phone: 407-493-4962
  • Fax:
Mailing address:
  • Phone: 407-493-4962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: