Healthcare Provider Details

I. General information

NPI: 1225604333
Provider Name (Legal Business Name): CHRISTOPHER JAMES MITCHELL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2021
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 SAN PABLO RD S
JACKSONVILLE FL
32224-1865
US

IV. Provider business mailing address

2366 IRONSTONE DR E
JACKSONVILLE FL
32246-9533
US

V. Phone/Fax

Practice location:
  • Phone: 904-953-2285
  • Fax:
Mailing address:
  • Phone: 904-910-7720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9114770
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: