Provider Demographics
NPI:1992777973
Name:MITCHELL, JULIA M (PA)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:M
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2452 MAHAN DR STE 101
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5377
Mailing Address - Country:US
Mailing Address - Phone:850-877-2126
Mailing Address - Fax:850-878-5190
Practice Address - Street 1:2452 MAHAN DR STE 101
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5377
Practice Address - Country:US
Practice Address - Phone:850-877-2126
Practice Address - Fax:850-878-5190
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA002304363A00000X
FLPA9105804363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA104589397AOtherPEACHSTATE
GA104589397AMedicaid
R80808Medicare UPIN
GA104589397AMedicaid