Provider Demographics
NPI:1306611264
Name:MIXA, ANNA TERESA (PA-C)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:TERESA
Last Name:MIXA
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 1:3612 EL CENTRO ST
Mailing Address - Street 2:
Mailing Address - City:ST PETE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33706-3908
Mailing Address - Country:US
Mailing Address - Phone:727-743-0728
Mailing Address - Fax:
Practice Address - Street 1:1609 PASADENA AVE S STE 1A
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-4514
Practice Address - Country:US
Practice Address - Phone:727-321-9644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-21
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9118132363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant