Provider Demographics
NPI:1760868301
Name:MAIS, MIZELL LIGON (CNA)
Entity Type:Individual
Prefix:
First Name:MIZELL
Middle Name:LIGON
Last Name:MAIS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:MRS
Other - First Name:MIZELL
Other - Middle Name:LIGON
Other - Last Name:MAIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:1245 PALM BAY RD
Mailing Address - Street 2:U 104
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-7620
Mailing Address - Country:US
Mailing Address - Phone:727-953-2226
Mailing Address - Fax:321-729-4347
Practice Address - Street 1:1245 PALM BAY RD
Practice Address - Street 2:U 104
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-7620
Practice Address - Country:US
Practice Address - Phone:727-953-2226
Practice Address - Fax:321-729-4347
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA39448376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide