Healthcare Provider Details

I. General information

NPI: 1851804553
Provider Name (Legal Business Name): MITCHELL GERALD PLANA BARROS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HEALTH PARK BLVD
SAINT AUGUSTINE FL
32086-5784
US

IV. Provider business mailing address

1301 PLANTATION ISLAND DR S STE 102B
SAINT AUGUSTINE FL
32080-3110
US

V. Phone/Fax

Practice location:
  • Phone: 904-819-5155
  • Fax:
Mailing address:
  • Phone: 904-315-2881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number35921
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number294088
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: