Provider Demographics
NPI:1134121767
Name:MITREGA, JOANNA (CNM)
Entity Type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:
Last Name:MITREGA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 S ANDREWS AVE
Mailing Address - Street 2:SUITE 321
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2510
Mailing Address - Country:US
Mailing Address - Phone:954-355-5110
Mailing Address - Fax:954-355-4919
Practice Address - Street 1:1600 S ANDREWS AVE
Practice Address - Street 2:SUITE 321
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2510
Practice Address - Country:US
Practice Address - Phone:954-355-5110
Practice Address - Fax:954-355-4919
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9182525367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304253700Medicaid
FLY059FYMedicare PIN
Q33859Medicare UPIN