Basic Information
| Provider Information | |||||||||
| NPI: | 1629581426 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | MRUDULA | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12470 TELECOM DR STE 300W | ||||||||
| Address2: | |||||||||
| City: | TEMPLE TERRACE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336370904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138718183 | ||||||||
| FaxNumber: | 8138718184 | ||||||||
| Practice Location | |||||||||
| Address1: | 12470 TELECOM DR STE 300W | ||||||||
| Address2: | |||||||||
| City: | TEMPLE TERRACE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336370904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138718200 | ||||||||
| FaxNumber: | 8133575501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2017 | ||||||||
| LastUpdateDate: | 09/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | AG10170094 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363L00000X | AG10170094 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.