Healthcare Provider Details

I. General information

NPI: 1598361925
Provider Name (Legal Business Name): ERICKA MUTZ FNP-C, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2020
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5004 S MACDILL AVE UNIT B
TAMPA FL
33611-3807
US

IV. Provider business mailing address

3690 W GANDY BLVD # 412
TAMPA FL
33611-2608
US

V. Phone/Fax

Practice location:
  • Phone: 813-333-5335
  • Fax: 813-738-1561
Mailing address:
  • Phone: 904-402-0711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.026328
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11007665
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95014786
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: