Healthcare Provider Details

I. General information

NPI: 1316145279
Provider Name (Legal Business Name): JEAN MULLOY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 11/02/2025
Certification Date: 11/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11911 NICKLAUS CIR
TAMPA FL
33624-4541
US

IV. Provider business mailing address

11911 NICKLAUS CIR
TAMPA FL
33624-4541
US

V. Phone/Fax

Practice location:
  • Phone: 813-877-1111
  • Fax:
Mailing address:
  • Phone: 813-877-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY5467
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: