Provider Demographics
NPI:1477815488
Name:MITCHELL, PATRICIA J (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13926
Mailing Address - Street 2:
Mailing Address - City:MEXICO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32410-3926
Mailing Address - Country:US
Mailing Address - Phone:850-273-8450
Mailing Address - Fax:423-803-4776
Practice Address - Street 1:256 CANAL STREET
Practice Address - Street 2:
Practice Address - City:PORT SAINT JOE
Practice Address - State:FL
Practice Address - Zip Code:32456
Practice Address - Country:US
Practice Address - Phone:850-273-8450
Practice Address - Fax:423-803-4776
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16928363LF0000X
GA208361363LF0000X
FL9411986363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000211956CMedicaid
GA000211956AMedicaid
GA111907Medicare Oscar/Certification
GA000211956AMedicaid
GA111960Medicare Oscar/Certification