Provider Demographics
NPI:1013935618
Name:MITCHELL, TONI ANITA (MD)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:ANITA
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 W CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-4156
Mailing Address - Country:US
Mailing Address - Phone:813-830-6905
Mailing Address - Fax:813-314-2045
Practice Address - Street 1:4200 W CYPRESS ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-4156
Practice Address - Country:US
Practice Address - Phone:813-830-6905
Practice Address - Fax:813-314-2045
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40152207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
94058XMedicare ID - Type Unspecified
C73773Medicare UPIN