MEDICARE: MRS. DELVENIA RENEE MITCHELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	693492797	FL
2	174400000X	Specialist	693492796	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346494903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DELVENIA RENEE MITCHELL

Provider Business Mailing Address
First Line	:	4515 N PEARL ST APT 2
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206
Country	:	US
Telephone Number	:	904-365-0799
Fax Number	:

Provider Business Practice Location Address
First Line	:	4515 N PEARL ST APT 2
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206
Country	:	US
Telephone Number	:	904-365-0799
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2008
Last Update Date	:	11/10/2008

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Directions to “ MRS. DELVENIA RENEE MITCHELL ” Practice Location

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