Healthcare Provider Details

I. General information

NPI: 1245151000
Provider Name (Legal Business Name): MIKEL PEZONAGA MUGUIRA FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13154 VILLAGE CHASE CIR
TAMPA FL
33618-8330
US

IV. Provider business mailing address

13154 VILLAGE CHASE CIR
TAMPA FL
33618-8330
US

V. Phone/Fax

Practice location:
  • Phone: 917-943-6820
  • Fax:
Mailing address:
  • Phone: 917-943-6820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11049544
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: