Provider Demographics
NPI:1164504262
Name:MUSSELWHITE, VIRGINIA DIANE (ARNP)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:DIANE
Last Name:MUSSELWHITE
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 1:2103 STONEBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6915
Mailing Address - Country:US
Mailing Address - Phone:352-243-2725
Mailing Address - Fax:352-383-2001
Practice Address - Street 1:18450 US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6707
Practice Address - Country:US
Practice Address - Phone:352-383-4966
Practice Address - Fax:352-383-2001
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP525252363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP04282Medicare UPIN
FLE3970ZMedicare ID - Type Unspecified