Provider Demographics
NPI:1205432705
Name:MITCHELL, RENAE TYLYNNE (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:MISS
First Name:RENAE
Middle Name:TYLYNNE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1734 E BEAUBIEN DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-4372
Mailing Address - Country:US
Mailing Address - Phone:480-738-3221
Mailing Address - Fax:
Practice Address - Street 1:17223 N CAVE CREEK RD UNIT 9
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2481
Practice Address - Country:US
Practice Address - Phone:480-738-3221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRNP251475363LF0000X, 207QA0401X, 207Q00000X
AZRN171399207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine