Healthcare Provider Details

I. General information

NPI: 1487595864
Provider Name (Legal Business Name): ELLIOT LOUIS MULLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 CHANNELSIDE DR
TAMPA FL
33602-5618
US

IV. Provider business mailing address

9716 TIFFANY OAKS LN
TAMPA FL
33612-7508
US

V. Phone/Fax

Practice location:
  • Phone: 181-339-6945
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: