Healthcare Provider Details

I. General information

NPI: 1619881729
Provider Name (Legal Business Name): ANASTASIA DEMETRIA MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 HOSPITAL DR
MARIANNA FL
32446-1917
US

IV. Provider business mailing address

3742 SKYVIEW RD
MARIANNA FL
32446-8348
US

V. Phone/Fax

Practice location:
  • Phone: 850-718-2561
  • Fax:
Mailing address:
  • Phone: 850-718-7986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number9519316
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: