Active NPI
Mia Kutanjac
- Pharmacist
- Orlando, FL
National Provider Identifier
1134957335
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS67293
- Practice address
- 1950 Sand Lake Rd BLDG 5
Orlando, FL 32809-7632 - Phone
- (855) 797-8254
- NPI assigned
- Jul 22, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS67293 | FL | Primary |
Addresses
Primary practice location
1950 Sand Lake Rd BLDG 5
Orlando, FL 32809-7632
Mailing address
16632 Lake Trail Dr Apt 102
Clermont, FL 34711-1141
Phone (954) 204-2485
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS67293 | FL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Publix Super Markets, Inc | Current | Accepting new patients |
Locations
1950 Sand Lake Rd
Bldg 5
Orlando, FL 32809
Phone (407) 856-2301
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721606400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721606400000",
"number": "1134957335",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16632 LAKE TRAIL DR APT 102",
"city": "CLERMONT",
"state": "FL",
"postal_code": "347111141",
"telephone_number": "954-204-2485"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1950 SAND LAKE RD BLDG 5",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328097632",
"telephone_number": "855-797-8254"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUTANJAC",
"first_name": "MIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-07-22",
"last_updated": "2024-07-22",
"certification_date": "2024-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS67293",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orlando, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.