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General NPI Number Information
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NPI Number | 1942031265
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Entity Type | Individual
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Provider Name | STEFANO THEMIO MITSAKIS
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Gender | Male
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Dates
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Enumeration Date | 08/08/2024
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Last Update Date | 08/09/2024
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Provider Practice Location Address
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Address Line | 1724 33RD ST STE 200
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City | ORLANDO
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State | FL
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Zip | 32839-8858
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Country | US
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Telephone | 407-917-8553
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Fax |
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Provider Business Mailing Address
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Address Line | 374 HIDDEN PALM CIR APT 204
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City | KISSIMMEE
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State | FL
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Zip | 34747-2032
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Country | US
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Telephone | 617-501-4384
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11034523
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License Number State | FL
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