Healthcare Provider Details

I. General information

NPI: 1952232498
Provider Name (Legal Business Name): EDITH MITCHELL CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

573 NARRAGANSETT ST NE
PALM BAY FL
32907-1330
US

IV. Provider business mailing address

573 NARRAGANSETT ST NE
PALM BAY FL
32907-1330
US

V. Phone/Fax

Practice location:
  • Phone: 321-848-7084
  • Fax:
Mailing address:
  • Phone: 321-848-7084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCNA435577
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: