Individual
MIKAYLA MARY LUISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2 TAMPA GENERAL CIR, TAMPA, FL 33606-3571
(813) 821-8038
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
(813) 821-8038
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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