Provider Demographics
NPI:1114403003
Name:CARREA, MITZI SERENA (FNP-C, RN-NIC)
Entity Type:Individual
Prefix:
First Name:MITZI
Middle Name:SERENA
Last Name:CARREA
Suffix:
Gender:F
Credentials:FNP-C, RN-NIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 WHEELER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:TN
Mailing Address - Zip Code:37327-4792
Mailing Address - Country:US
Mailing Address - Phone:904-652-9890
Mailing Address - Fax:
Practice Address - Street 1:74 WHEELER RIDGE RD
Practice Address - Street 2:
Practice Address - City:DUNLAP
Practice Address - State:TN
Practice Address - Zip Code:37327-4792
Practice Address - Country:US
Practice Address - Phone:904-652-9890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-14
Last Update Date:2018-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24442363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily