Provider Demographics
NPI:1740094044
Name:MITCHELL, TAMARA MICHELLE (LPN)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:MICHELLE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SEDERHOLM PATH
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-5479
Mailing Address - Country:US
Mailing Address - Phone:386-225-0208
Mailing Address - Fax:
Practice Address - Street 1:7 SEDERHOLM PATH
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-5479
Practice Address - Country:US
Practice Address - Phone:386-225-0208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5179703164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse