MEDICARE: MUKIA MYRICK

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1598389165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUKIA MYRICK

Provider Business Mailing Address
First Line	:	2431 ALOMA AVE STE 255
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-2541
Country	:	US
Telephone Number	:	407-765-8966
Fax Number	:

Provider Business Practice Location Address
First Line	:	630 CORAL GLEN LOOP APT 101
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-1791
Country	:	US
Telephone Number	:	407-765-8966
Fax Number	:

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

Provider Enumeration Date	:	05/29/2020
Last Update Date	:	05/29/2020

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Directions to “ MUKIA MYRICK ” Practice Location

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