Healthcare Provider Details

I. General information

NPI: 1730760257
Provider Name (Legal Business Name): MITCHELL ARTHUR JOSEPH GULLIFER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4725 US HIGHWAY 98 S STE 101-102
LAKELAND FL
33812-4334
US

IV. Provider business mailing address

3334 CAPITAL MEDICAL BLVD STE 400
TALLAHASSEE FL
32308-4470
US

V. Phone/Fax

Practice location:
  • Phone: 863-274-9700
  • Fax: 863-328-9700
Mailing address:
  • Phone: 850-877-8174
  • Fax: 844-261-6839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: