Provider Information for 1518562479
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JERRILYNN PRATT-MULLEN
Sex: Female
NPI: 1518562479
Last Updated: 2020-11-30
Certification Date: 2020-11-30
Certification Date: 2020-11-30
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1518562479 | ||||||||
| Enumeration Date | 2020-11-30 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 5720 13TH AVE N APT 303B SAINT PETERSBURG, FL 33710-5874 United States Phone: 518-645-0913 | Fax: | ||||||||
| Primary Practice Address | 5720 13TH AVE N APT 303B SAINT PETERSBURG, FL 33710-5874 United States Phone: 518-645-0913 | Fax: | ||||||||
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