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General NPI Number Information
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NPI Number | 1760868301
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Entity Type | Individual
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Provider Name | MIZELL LIGON MAIS CNA
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Gender | Female
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Dates
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Enumeration Date | 08/05/2015
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Last Update Date | 08/05/2015
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Provider Practice Location Address
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Address Line | 1245 PALM BAY RD U 104
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City | PALM BAY
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State | FL
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Zip | 32905-7620
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Country | US
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Telephone | 727-953-2226
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Fax | 321-729-4347
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Provider Business Mailing Address
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Address Line | 1245 PALM BAY RD U 104
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City | PALM BAY
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State | FL
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Zip | 32905-7620
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Country | US
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Telephone | 727-953-2226
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Fax | 321-729-4347
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | CNA39448
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License Number State | FL
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