Individual
MIKAYLA MARY LUISE
Active
Individual
MIKAYLA MARY LUISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5243
CT
363AS0400X
Surgical Physician Assistant
Primary
PA9121079
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1185X
BCBS
FL
05
—
130110100
—
FL
Enumeration date
06/09/2021
Last updated
03/23/2026
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