Healthcare Provider Details

I. General information

NPI: 1487463501
Provider Name (Legal Business Name): SUADA MUMINOVIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 W TWINCOURT TRL STE AND702
SAINT AUGUSTINE FL
32095-8884
US

IV. Provider business mailing address

13826 ZION GATE CT
JACKSONVILLE FL
32224-0283
US

V. Phone/Fax

Practice location:
  • Phone: 904-990-0028
  • Fax:
Mailing address:
  • Phone: 904-514-1471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11036245
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: