Muhammad Numaan Imam

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

11029167 Issued in FL

Practice address

466 Woodford Dr
Debary, FL 32713-2145

Phone

(813) 580-0163

NPI assigned

Oct 4, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL, NH, CT3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Caremed Urgent Care LLC

  • Urgent Care Clinic/Center
  • Marianna, FL
  • NPI 1548902984
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1664841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712275200000",
    "number": "1407571391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "466 WOODFORD DR",
            "city": "DEBARY",
            "state": "FL",
            "postal_code": "327132145",
            "telephone_number": "813-580-0163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "466 WOODFORD DR",
            "city": "DEBARY",
            "state": "FL",
            "postal_code": "327132145",
            "telephone_number": "813-580-0163"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4600 Touchton Rd E Ste 150",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322468299",
            "country_code": "US",
            "telephone_number": "800-465-3203",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5455 Almira Dr NE",
            "address_purpose": "LOCATION",
            "city": "Bremerton",
            "state": "WA",
            "postal_code": "983118330",
            "country_code": "US",
            "telephone_number": "360-373-5031",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IMAM",
        "first_name": "MUHAMMAD",
        "middle_name": "NUMAAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-10-04",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "11029167",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WA",
            "license": "RN61318363",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Humberto a Dominguez MD PA
• Shermaine Humphrey
• Shawneece Evangellette Hunt
• Magued Ibrahim, M.D.
• Imam Psychiatry
• Impulse Chiropractic and Rehab LLC
• Integrative Physical Medicine of Debary, LLC
• Integrity Behavioral & Coaching Solutions,LLC
• Internal Medicine at Debary LLC
• International Wudang Internal Martial Arts Research Association

• Psychiatric/Mental Health Nurse Practitioner in Debary, FL
• Providers in Debary, FL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.