Provider Demographics
NPI:1487463501
Name:MUMINOVIC, SUADA
Entity type:Individual
Prefix:
First Name:SUADA
Middle Name:
Last Name:MUMINOVIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13826 ZION GATE CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-0283
Mailing Address - Country:US
Mailing Address - Phone:904-514-1471
Mailing Address - Fax:
Practice Address - Street 1:533 W TWINCOURT TRL STE AND702
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-8884
Practice Address - Country:US
Practice Address - Phone:904-990-0028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-03
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11036245363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily