Healthcare Provider Details

I. General information

NPI: 1508191958
Provider Name (Legal Business Name): JANA MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2009
Last Update Date: 10/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E SOUTH ST UNIT 6060
ORLANDO FL
32801-3556
US

IV. Provider business mailing address

1525 S ALAFAYA TRL STE 101
ORLANDO FL
32828-8926
US

V. Phone/Fax

Practice location:
  • Phone: 321-276-0838
  • Fax:
Mailing address:
  • Phone: 407-340-4167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ4921
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: