Individual
MRS. MARTHA M MIXA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
5959 CENTRAL AVE, STE 101, ST PETERSBURG, FL 33710-8502
(727) 321-9644
(727) 321-8580
Mailing address
5959 CENTRAL AVE, STE 101, ST PETERSBURG, FL 33710-8502
(727) 321-9644
(727) 321-8580
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9105230
FL
363AS0400X
Surgical Physician Assistant
PA9105230
FL
Other
Enumeration date
10/22/2009
Last updated
10/23/2009
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