Adrienne Denise Mubarak, APN

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

APRN9378786 Issued in FL

Practice address

30 Edgely LN
Palm Coast, FL 32164-6353

Phone

(773) 457-9000

NPI assigned

Jun 1, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Interoperability endpoints

• Direct secure messaging: adrienne.mubarak.1@15445.direct.athenahealth.com

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

{
    "created_epoch": "1306886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566172800000",
    "number": "1972897403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 EDGELY LN",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321646353",
            "telephone_number": "773-457-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 EDGELY LN",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321646353",
            "telephone_number": "773-457-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUBARAK",
        "first_name": "ADRIENNE",
        "middle_name": "DENISE",
        "name_prefix": "Mrs.",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-01",
        "last_updated": "2019-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "FL",
            "license": "APRN9378786",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL RN LICENSE",
            "identifier": "RN9378786",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL APRN LICENSE",
            "identifier": "APRN9378786",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Motherlycare Assisted Living Facility, LLC
• Brandon Mott, D.P.T.
• Moultrie Inpatient Physicians
• Nina M Moyer, PHD
• Mua Center of Palm Coast LLC
• Lauren Mulligan, M.S., CCC-SLP
• Maha Muneer
• William L Murphy
• Jean Murpy
• Brandon Murray

• Gerontology Nurse Practitioner in Palm Coast, FL
• Providers in Palm Coast, FL by specialty
• Gerontology Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2019; 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.