Provider Demographics
NPI:1922571843
Name:PITTMAN, MANDIE M (NP-C)
Entity Type:Individual
Prefix:
First Name:MANDIE
Middle Name:M
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5952 BERRYHILL RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-4009
Mailing Address - Country:US
Mailing Address - Phone:850-726-8123
Mailing Address - Fax:
Practice Address - Street 1:5952 BERRYHILL RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-4009
Practice Address - Country:US
Practice Address - Phone:850-651-3376
Practice Address - Fax:850-651-3372
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9308436363L00000X, 363LG0600X, 363LA2200X
FLARNP9308436363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology