1700168085 NPI number — PRAXIDES MUKOCHE MBAKAYA-CHEN ARNP

Table of content: PRAXIDES MUKOCHE MBAKAYA-CHEN ARNP (NPI 1700168085)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700168085 NPI number — PRAXIDES MUKOCHE MBAKAYA-CHEN ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MBAKAYA-CHEN
Provider First Name:
PRAXIDES
Provider Middle Name:
MUKOCHE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700168085
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1020 LAKE SUMTER LNDG
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THE VILLAGES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32162-2699
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-674-8905
Provider Business Mailing Address Fax Number:
352-674-8901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
280 FARNER PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THE VILLAGES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32163-6066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-884-9355
Provider Business Practice Location Address Fax Number:
352-674-8910
Provider Enumeration Date:
09/13/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  ARNP 9323763 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: APRN9323763 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004023800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: FK403Z . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 004023800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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