Healthcare Provider Details

I. General information

NPI: 1285548578
Provider Name (Legal Business Name): TANTANISHA N MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11517 PALMETTO PINE ST
RIVERVIEW FL
33569-6229
US

IV. Provider business mailing address

11517 PALMETTO PINE ST
RIVERVIEW FL
33569-6229
US

V. Phone/Fax

Practice location:
  • Phone: 727-906-6273
  • Fax:
Mailing address:
  • Phone: 727-906-6273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9356145
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: