Healthcare Provider Details

I. General information

NPI: 1033648647
Provider Name (Legal Business Name): PATRICK JAMES MIXA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 PASADENA AVE S STE 1A
SOUTH PASADENA FL
33707-4514
US

IV. Provider business mailing address

1609 PASADENA AVE S STE 1A
SOUTH PASADENA FL
33707-4514
US

V. Phone/Fax

Practice location:
  • Phone: 727-321-9644
  • Fax: 727-321-8580
Mailing address:
  • Phone: 727-321-9644
  • Fax: 727-321-8580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD94101
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME166702
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: