Healthcare Provider Details

I. General information

NPI: 1780213272
Provider Name (Legal Business Name): NAILAH MUBIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 COLUMBIA ST STE 400
ORLANDO FL
32806-1115
US

IV. Provider business mailing address

60 COLUMBIA ST STE 400
ORLANDO FL
32806-1115
US

V. Phone/Fax

Practice location:
  • Phone: 321-843-5851
  • Fax: 321-843-7381
Mailing address:
  • Phone: 321-843-5851
  • Fax: 321-843-7381

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 Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS21889
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: