Provider Demographics
NPI:1437335940
Name:MITCHELL, PAUL JR (CCC,LPN)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:MITCHELL
Suffix:JR
Gender:M
Credentials:CCC,LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 CURA CT
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34787-8955
Mailing Address - Country:US
Mailing Address - Phone:407-373-5924
Mailing Address - Fax:407-614-4956
Practice Address - Street 1:802 CURA CT
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:FL
Practice Address - Zip Code:34787-8955
Practice Address - Country:US
Practice Address - Phone:407-373-5924
Practice Address - Fax:407-614-4956
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN1001541164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse