1477815488 NPI number — PATRICIA J MITCHELL APRN, FNP-C

Table of content: PATRICIA J MITCHELL APRN, FNP-C (NPI 1477815488)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477815488 NPI number — PATRICIA J MITCHELL APRN, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITCHELL
Provider First Name:
PATRICIA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, FNP-C
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:
1477815488
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 13926
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEXICO BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32410-3926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-273-8450
Provider Business Mailing Address Fax Number:
423-803-4776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
256 CANAL STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT SAINT JOE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-273-8450
Provider Business Practice Location Address Fax Number:
423-803-4776
Provider Enumeration Date:
06/14/2012

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: 363LF0000X , with the licence number:  16928 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 208361 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 9411986 , 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: 000211956C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000211956A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".