=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003575523
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MUTINTA YVONNE TEMBO PMHNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2021
-----------------------------------------------------
Last Update Date | 04/27/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9332 STATE ROAD 54 STE 307
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34655-1810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-999-3311
-----------------------------------------------------
Fax | 727-478-4966
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9332 STATE ROAD 54 STE 307
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34655-1810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-999-3311
-----------------------------------------------------
Fax | 727-478-4966
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | APRN11016497
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------