Healthcare Provider Details

I. General information

NPI: 1760208912
Provider Name (Legal Business Name): SOPHONIE MITIL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 N DIXIE HWY
POMPANO BEACH FL
33060-5621
US

IV. Provider business mailing address

817 N DIXIE HWY
POMPANO BEACH FL
33060-5621
US

V. Phone/Fax

Practice location:
  • Phone: 954-785-8285
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11042611
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: