Healthcare Provider Details

I. General information

NPI: 1003736505
Provider Name (Legal Business Name): MITZI LE FNP-C, ENP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11131 JOURNAL PKWY STE A
KING GEORGE VA
22485-3468
US

IV. Provider business mailing address

7552 NAVARRE PKWY UNIT 62
NAVARRE FL
32566-7305
US

V. Phone/Fax

Practice location:
  • Phone: 540-741-6982
  • Fax:
Mailing address:
  • Phone: 850-298-8429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024196132
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: