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MULBERRYS MOBILE PROVIDER SERVICES NPI 1831683861


NPI Information

NPI: 1831683861
Provider Name: MULBERRYS MOBILE PROVIDER SERVICES

Other Name: MULBERRYS MOBILE PROVIDER SERVICES, LLC

Classification: General Practice - 208D00000X
Entity Type: Organization

CLIA Number: 10D2189504

Address:
6435 SE US HIGHWAY 301
HAWTHORNE, FL
ZIP 32640
Phone: (352) 358-8070
Get Directions

MULBERRYS MOBILE PROVIDER SERVICES is a general practice in Hawthorne, FL. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee MULBERRYS MOBILE PROVIDER SERVICES NPI is 1831683861. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Other Name Is Mulberrys Mobile Provider Services, Llc.

The provider's business location address is:

6435 SE US HIGHWAY 301
HAWTHORNE, FL
ZIP 32640-309
Phone: (352) 358-8070
Fax: (949) 577-4783

The provider's authorized official is Michell Mulberry .
The authorized official title is Provider, Owner and has the following contact phone number (352) 358-8070.

The CLIA number assigned to this NPI record is 10D2189504 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/22/2018 and was last updated on 2/8/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LA2200XNurse PractitionerAdult HealthNo
2363LP2300XNurse PractitionerPrimary CareNo
3208D00000XGeneral PracticeYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1107001000MEDICAIDFLORIDA
2106245700MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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