Healthcare Provider Details

I. General information

NPI: 1144756172
Provider Name (Legal Business Name): JOANNA MULDER NP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13739 OGAKOR DR
RIVERVIEW FL
33579-2303
US

IV. Provider business mailing address

13739 OGAKOR DR
RIVERVIEW FL
33579-2303
US

V. Phone/Fax

Practice location:
  • Phone: 813-940-6046
  • Fax: 866-451-4607
Mailing address:
  • Phone: 813-940-6046
  • Fax: 866-451-4607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE E ELLISON
Title or Position: OWNER
Credential:
Phone: 813-376-0742