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General NPI Number Information
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NPI Number | 1669921813
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Entity Type | Individual
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Provider Name | SHAZIA MITHA MPHIL, AGACNP-BC, RN
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Gender | Female
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Dates
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Enumeration Date | 09/29/2016
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 3250 ZEMKE AVE
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City | TAMPA
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State | FL
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Zip | 33621-5023
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Country | US
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Telephone | 813-827-9724
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Fax |
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Provider Business Mailing Address
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Address Line | 2995 DREW ST
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City | CLEARWATER
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State | FL
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Zip | 33759-3012
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Country | US
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Telephone | 727-315-7496
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 717809
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | F431274
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN11011268
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License Number State | FL
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