MEDICARE: FITZWILLIAM ESELE MUSOKO APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	APRN9342679	FL
2	363LF0000X	Family Nurse Practitioner	APRN9342679	FL
3	363L00000X	Nurse Practitioner	827678	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AJW4L	OTHER	FL	BCBS
2	APRN9342679	OTHER		FL LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	APRN827678	OTHER	NV	NV APRN LICENSE

General Provider Information

NPI Number	:	1003360058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FITZWILLIAM ESELE MUSOKO APRN

Provider Business Mailing Address
First Line	:	464 BEARDSLEY CIR
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-2670
Country	:	US
Telephone Number	:	813-420-5470
Fax Number	:

Provider Business Practice Location Address
First Line	:	1024 W OWENS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-2520
Country	:	US
Telephone Number	:	813-420-5470
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2016
Last Update Date	:	03/07/2023

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