Healthcare Provider Details

I. General information

NPI: 1477457356
Provider Name (Legal Business Name): MINDY EMMANUEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 CAPITAL MEDICAL BLVD
TALLAHASSEE FL
32308-4402
US

IV. Provider business mailing address

1600 PULLEN RD APT 10B
TALLAHASSEE FL
32303-3649
US

V. Phone/Fax

Practice location:
  • Phone: 954-696-7677
  • Fax:
Mailing address:
  • Phone: 954-696-7677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9639750
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: