Provider Demographics
NPI:1326926155
Name:MITCHELL, DEBRA A
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 SENATE CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3142
Mailing Address - Country:US
Mailing Address - Phone:813-789-1313
Mailing Address - Fax:
Practice Address - Street 1:2810 E HILLSBOROUGH AVE # 311252
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-4446
Practice Address - Country:US
Practice Address - Phone:813-693-1486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X, 174400000X
175T00000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialist
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer Specialist
No372600000XNursing Service Related ProvidersAdult Companion