Provider Demographics
NPI:1831203769
Name:MITNICK, CAROL A (ARNP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:MITNICK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4035 EVANS AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9308
Mailing Address - Country:US
Mailing Address - Phone:239-939-7375
Mailing Address - Fax:
Practice Address - Street 1:EMPLOYEE HEALTH
Practice Address - Street 2:9981 SOUTH HEALTHPARK
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908
Practice Address - Country:US
Practice Address - Phone:239-432-4190
Practice Address - Fax:239-432-4243
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1373222363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL033308500Medicaid