Provider Demographics
NPI:1639585177
Name:MUSTAFA, ISIN
Entity type:Individual
Prefix:
First Name:ISIN
Middle Name:
Last Name:MUSTAFA
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 1:6326 FORT KING RD
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-2531
Mailing Address - Country:US
Mailing Address - Phone:813-788-3600
Mailing Address - Fax:813-788-7010
Practice Address - Street 1:6326 FORT KING RD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-2531
Practice Address - Country:US
Practice Address - Phone:813-788-3600
Practice Address - Fax:813-788-7010
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-04
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003815213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist