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General NPI Number Information
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NPI Number | 1952150211
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Entity Type | Individual
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Provider Name | MADISON MULLIS
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Gender | Female
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Dates
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Enumeration Date | 05/17/2024
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 1950 ARLINGTON ST STE 203
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City | SARASOTA
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State | FL
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Zip | 34239-3516
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Country | US
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Telephone | 941-379-6331
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Fax | 941-379-5443
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Provider Business Mailing Address
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Address Line | 2175 W DOLPHIN DR
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City | ENGLEWOOD
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State | FL
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Zip | 34223-6310
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Country | US
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Telephone | 941-716-4788
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9119173
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License Number State | FL
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