MEDICARE: MRS. KRISTIN ELIZABETH MITCHELL MSN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	ARNP 9367885	FL
2	363L00000X	Nurse Practitioner	9367885	FL

General Provider Information

NPI Number	:	1881053163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTIN ELIZABETH MITCHELL MSN, FNP-C

Provider Business Mailing Address
First Line	:	3271 TAMIAMI TRL STE A
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-8032
Country	:	US
Telephone Number	:	732-589-3556
Fax Number	:

Provider Business Practice Location Address
First Line	:	3271 TAMIAMI TRL STE A
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-8032
Country	:	US
Telephone Number	:	732-589-3556
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2016
Last Update Date	:	03/17/2021

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