Provider Demographics
NPI:1194710848
Name:MITCHELL, CATRENA B (PA C)
Entity type:Individual
Prefix:
First Name:CATRENA
Middle Name:B
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3109 MEDICAL WAY
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-5548
Mailing Address - Country:US
Mailing Address - Phone:863-386-0786
Mailing Address - Fax:863-386-1848
Practice Address - Street 1:3109 MEDICAL WAY
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5548
Practice Address - Country:US
Practice Address - Phone:863-386-0786
Practice Address - Fax:863-386-1848
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9101227363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0088ZMedicare ID - Type Unspecified
P79981Medicare UPIN