Provider Demographics
NPI:1174042212
Name:MUNGIN, KING DAVID SR (ARNP)
Entity type:Individual
Prefix:MR
First Name:KING
Middle Name:DAVID
Last Name:MUNGIN
Suffix:SR
Gender:M
Credentials:ARNP
Other - Prefix:MR
Other - First Name:KING
Other - Middle Name:DAVID
Other - Last Name:MUNGIN
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:6520 FORT CAROLINE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-2044
Mailing Address - Country:US
Mailing Address - Phone:904-745-3618
Mailing Address - Fax:904-722-4271
Practice Address - Street 1:725 N 12TH AVE BLDG B
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-8752
Practice Address - Country:US
Practice Address - Phone:863-494-1242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-10
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3379032363LF0000X
FLAPRN3379032363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily