Individual
MRS. AMANDA RENIA MIZELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
1212 E PASS RD, GULFPORT, MS 39507-3403
(228) 896-7108
(228) 896-7174
Mailing address
PO BOX 787, GRAND BAY, AL 36541-0787
(228) 896-7108
(228) 896-7174
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
1-111977
AL
363LF0000X
Family Nurse Practitioner
Primary
R880871
MS
Other
Enumeration date
03/05/2010
Last updated
02/14/2023
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