Basic Information
| Provider Information | |||||||||
| NPI: | 1376886341 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MULA | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 37920 MEDICAL ARTS CT | ||||||||
| Address2: | |||||||||
| City: | ZEPHYRHILLS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335414323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525182000 | ||||||||
| FaxNumber: | 3525670218 | ||||||||
| Practice Location | |||||||||
| Address1: | 37920 MEDICAL ARTS CT | ||||||||
| Address2: | |||||||||
| City: | ZEPHYRHILLS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335414323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525182000 | ||||||||
| FaxNumber: | 3525670218 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2013 | ||||||||
| LastUpdateDate: | 04/13/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208M00000X | 79219 | GA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | OS13876 | 01 | FL | LICENSE | OTHER |