Healthcare Provider Details

I. General information

NPI: 1417618505
Provider Name (Legal Business Name): AZIZA MUSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2022
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N ALEXANDER ST
PLANT CITY FL
33563-4302
US

IV. Provider business mailing address

210 N ALEXANDER ST STE B
PLANT CITY FL
33563-4302
US

V. Phone/Fax

Practice location:
  • Phone: 813-719-3525
  • Fax: 813-719-3175
Mailing address:
  • Phone: 813-719-3525
  • Fax: 813-719-3175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF12210954
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: