Healthcare Provider Details

I. General information

NPI: 1477475507
Provider Name (Legal Business Name): MARIA ALANA MITCHELL LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 SW PROSPERITY PL
LAKE CITY FL
32024-0684
US

IV. Provider business mailing address

310 JUDSON DR
PERRY FL
32348-4765
US

V. Phone/Fax

Practice location:
  • Phone: 386-269-3900
  • Fax:
Mailing address:
  • Phone: 850-371-9012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN5259275
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: