Provider Demographics
NPI:1295846533
Name:MITCHELL, JENNIFER MARGUERITE (LM)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARGUERITE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 NW 64TH TER
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-7708
Mailing Address - Country:US
Mailing Address - Phone:954-260-5730
Mailing Address - Fax:
Practice Address - Street 1:601 NW 64TH TER
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-7708
Practice Address - Country:US
Practice Address - Phone:954-260-5730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW633747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider