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General NPI Number Information
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NPI Number | 1285640227
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Entity Type | Individual
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Provider Name | JOHNNIE LARA MITCHELL ACNP-BC, RNFA
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Gender | Female
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 7614 LOCKWOOD RIDGE RD
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City | SARASOTA
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State | FL
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Zip | 34243-4900
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Country | US
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Telephone | 941-777-5673
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Fax |
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Provider Business Mailing Address
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Address Line | 12755 157TH ST N
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City | JUPITER
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State | FL
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Zip | 33478-6671
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Country | US
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Telephone | 561-252-4170
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 2831402
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number | 2831402
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 2831402
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License Number State | FL
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