Individual
DIANA NASSER MUSTAFA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1707 W REYNOLDS ST, PLANT CITY, FL 33563-4737
(813) 756-5695
Mailing address
701 FLORESTA ST, BRANDON, FL 33511-6530
(813) 545-1384
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9115124
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114798100
—
FL
01
—
PI885
HF MA
FL
Enumeration date
05/05/2022
Last updated
07/20/2022
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