Provider Demographics
NPI:1194702399
Name:MRAZ, JOYCE J (ARNP,RN)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:J
Last Name:MRAZ
Suffix:
Gender:F
Credentials:ARNP,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3564 AVALON PARK EAST BLVD STE 133
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7365
Mailing Address - Country:US
Mailing Address - Phone:407-657-9368
Mailing Address - Fax:407-823-3082
Practice Address - Street 1:3564 AVALON PARK EAST BLVD STE 133
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7365
Practice Address - Country:US
Practice Address - Phone:407-657-9368
Practice Address - Fax:407-823-3082
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1204432363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306794700Medicaid
FLP28247Medicare UPIN
FL306794700Medicaid