Healthcare Provider Details

I. General information

NPI: 1104551464
Provider Name (Legal Business Name): JASON MUSCARI FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 07/20/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 EUBANK BLVD NE STE 32
ALBUQUERQUE NM
87111-6127
US

IV. Provider business mailing address

6800 VISTA DEL NORTE RD NE APT 2526
ALBUQUERQUE NM
87113-1367
US

V. Phone/Fax

Practice location:
  • Phone: 505-200-2860
  • Fax:
Mailing address:
  • Phone: 917-626-8953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number69049
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: