Provider Demographics
NPI:1588024285
Name:MITCHELL, KERRYROSE JOYCEANN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KERRYROSE
Middle Name:JOYCEANN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KERRYROSE
Other - Middle Name:JOYCEANN
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:7800 SW 87TH AVENUE
Mailing Address - Street 2:SUITE C-340
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173
Mailing Address - Country:US
Mailing Address - Phone:305-595-0109
Mailing Address - Fax:305-595-7092
Practice Address - Street 1:600 NORTH HIATUS ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026
Practice Address - Country:US
Practice Address - Phone:954-431-0540
Practice Address - Fax:954-431-0520
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9287130163W00000X
FL9287130363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse