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General NPI Number Information
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NPI Number | 1639827033
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Entity Type | Organization
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Legal Business Name | MOSAIC MEDICINE, PLLC
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Dates
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Enumeration Date | 03/15/2022
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 3934 E STATE ROAD 64
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City | BRADENTON
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State | FL
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Zip | 34208-9059
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Country | US
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Telephone | 703-677-1035
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Fax | 941-200-4264
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Provider Business Mailing Address
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Address Line | 11161 STATE ROAD 70 E UNIT 110-876
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-9407
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Country | US
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Telephone | 703-677-1035
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. CORY LUCAS
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Credential | NP-C, ENP
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Telephone | 941-777-5665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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