Provider Demographics
NPI:1033920558
Name:MENDEZ, MIKAELA (PA-C)
Entity type:Individual
Prefix:
First Name:MIKAELA
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 NE 10TH ST APT 308
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2524
Mailing Address - Country:US
Mailing Address - Phone:954-600-1184
Mailing Address - Fax:
Practice Address - Street 1:900 S PINE ISLAND RD STE 100
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3920
Practice Address - Country:US
Practice Address - Phone:954-587-4218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant