Individual
JONATHAN MIZGALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DNP, FNP-BC
Contact information
Practice address
55 CENTRAL PLZ STE B, ILION, NY 13357-1753
(315) 444-1900
(315) 363-2549
Mailing address
1 S WASHINGTON ST STE 300, ROCHESTER, NY 14614-1134
(585) 325-2280
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
342409
NY
363L00000X
Nurse Practitioner
F342409
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
405393
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05296391
—
NY
Enumeration date
01/11/2017
Last updated
12/13/2023
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