Provider Demographics
NPI:1619428026
Name:MUKENA, BIBISH
Entity type:Individual
Prefix:
First Name:BIBISH
Middle Name:
Last Name:MUKENA
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 1:102 W PINELOCH AVE STE 23
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6100
Mailing Address - Country:US
Mailing Address - Phone:407-852-2760
Mailing Address - Fax:321-843-6729
Practice Address - Street 1:102 W PINELOCH AVE STE 23
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-6100
Practice Address - Country:US
Practice Address - Phone:407-852-2760
Practice Address - Fax:321-843-6729
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6731363LF0000X
NYF339941363LF0000X
TXAP135197363LF0000X
FLAPRN11034059363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily