MEDICARE: MIOK RAY NP

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	363LW0102X	Women's Health Nurse Practitioner	ARNP9306708	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487838645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIOK RAY NP

Provider Business Mailing Address
First Line	:	4321 N MACDILL AVE STE 203
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6390
Country	:	US
Telephone Number	:	813-873-7615
Fax Number	:	813-443-8134

Provider Business Practice Location Address
First Line	:	4321 N MACDILL AVE STE 203
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6390
Country	:	US
Telephone Number	:	813-873-7615
Fax Number	:	813-443-8134

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

Provider Enumeration Date	:	12/24/2007
Last Update Date	:	04/08/2022

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