Healthcare Provider Details

I. General information

NPI: 1801524087
Provider Name (Legal Business Name): IZABELL MINGUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1452 BLOOMINGDALE AVE
VALRICO FL
33596-6110
US

IV. Provider business mailing address

9521 DELANEY CREEK BLVD APT 106
TAMPA FL
33619-5185
US

V. Phone/Fax

Practice location:
  • Phone: 813-616-4004
  • Fax:
Mailing address:
  • Phone: 252-259-6131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ13275
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: