Provider Demographics
NPI:1750335493
Name:MITCHELL, LORRAINE NOREEN (MD)
Entity type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:NOREEN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:NOREEN
Other - Last Name:JARVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1502 N DONNELLY ST STE 103
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-2846
Mailing Address - Country:US
Mailing Address - Phone:352-383-0624
Mailing Address - Fax:
Practice Address - Street 1:1502 N DONNELLY ST STE 103
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-2846
Practice Address - Country:US
Practice Address - Phone:352-383-0624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9401421208000000X
FLME130337208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262822800Medicaid
NC89127NXMedicaid