Provider Demographics
NPI:1396611877
Name:WARD, MITCHELL ALEXANDER (PA-C)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:ALEXANDER
Last Name:WARD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5649 MELVIN DR
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32163-5736
Mailing Address - Country:US
Mailing Address - Phone:717-810-7480
Mailing Address - Fax:
Practice Address - Street 1:5649 MELVIN DR
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-5736
Practice Address - Country:US
Practice Address - Phone:717-810-7480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant