Individual
TERRI MITCHELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3840 NW 178TH ST, MIAMI GARDENS, FL 33055-3859
(305) 622-2651
Mailing address
3840 NW 178TH ST, MIAMI GARDENS, FL 33055-3859
(305) 622-2651
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
CFCE 1207-1703-95
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300122900
MEDICAID PROVIDER NUMBER
FL
Enumeration date
04/24/2008
Last updated
04/24/2008
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