Provider Demographics
NPI:1477095644
Name:MITCHELL, CAROL MARVALYN
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:MARVALYN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CAROL
Other - Middle Name:MARVALYN
Other - Last Name:CHRISTIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:8531 NW 27TH DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5363
Mailing Address - Country:US
Mailing Address - Phone:954-234-5384
Mailing Address - Fax:
Practice Address - Street 1:8531 NW 27TH DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5363
Practice Address - Country:US
Practice Address - Phone:954-234-5384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9182786363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily