Provider Demographics
NPI:1508012444
Name:MITCHELL, NASSTASIA M (BS)
Entity Type:Individual
Prefix:MS
First Name:NASSTASIA
Middle Name:M
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 N BRINK AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-5311
Mailing Address - Country:US
Mailing Address - Phone:941-861-3385
Mailing Address - Fax:941-861-2719
Practice Address - Street 1:7820 S TAMIAMI TRAIL
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-0000
Practice Address - Country:US
Practice Address - Phone:941-861-3385
Practice Address - Fax:941-861-2719
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker