Healthcare Provider Details

I. General information

NPI: 1932496783
Provider Name (Legal Business Name): MOBILE MEDICAL ASSOCIATES, P.L.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4181 SW HIGH MEADOWS AVE
PALM CITY FL
34990-3725
US

IV. Provider business mailing address

4181 SW HIGH MEADOWS AVE
PALM CITY FL
34990-3725
US

V. Phone/Fax

Practice location:
  • Phone: 772-221-7620
  • Fax: 772-221-9903
Mailing address:
  • Phone: 772-221-7620
  • Fax: 772-221-9903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LAURIE GRISSMAN MCCUEN
Title or Position: PRESIDENT
Credential: ARNP, DNP
Phone: 772-221-7620