Provider Demographics
NPI:1992993489
Name:MULVIHILL, JEANNE DENISE (ARNP)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:DENISE
Last Name:MULVIHILL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 WILSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-9685
Mailing Address - Country:US
Mailing Address - Phone:727-560-9973
Mailing Address - Fax:
Practice Address - Street 1:1106 DRUID RD S
Practice Address - Street 2:SUITE 302
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3846
Practice Address - Country:US
Practice Address - Phone:727-441-3711
Practice Address - Fax:727-441-3716
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1704602363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308752200Medicaid
AH291Medicare PIN