MEDICARE: CARLOS MARIO MUJICA 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	363LF0000X	Family Nurse Practitioner	11016795	FL

General Provider Information

NPI Number	:	1265191803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS MARIO MUJICA APRN

Provider Business Mailing Address
First Line	:	6747 RALSTON BEACH CIR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-4207
Country	:	US
Telephone Number	:	813-580-2268
Fax Number	:

Provider Business Practice Location Address
First Line	:	13302 WINDING OAK CT STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-3425
Country	:	US
Telephone Number	:	813-930-8424
Fax Number	:

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

Provider Enumeration Date	:	12/10/2021
Last Update Date	:	12/10/2021

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Directions to “ CARLOS MARIO MUJICA APRN” Practice Location

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