Individual
TRACIE LEDORA MITCHEM-GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
F.N.P
Contact information
Practice address
295 NW COMMONS LOOP # 115-105, LAKE CITY, FL 32055-7721
(803) 381-7690
Mailing address
295 NW COMMONS LOOP # 115-105, LAKE CITY, FL 32055-7721
(803) 381-7690
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
2981
SC
363LF0000X
Family Nurse Practitioner
9304575
FL
363LP2300X
Primary Care Nurse Practitioner
Primary
2981
SC
363LP2300X
Primary Care Nurse Practitioner
342892
NY
363LP2300X
Primary Care Nurse Practitioner
ARNP9304575
FL
Other
Enumeration date
04/02/2007
Last updated
05/10/2018
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