Active NPI
Jack Mixner, MS, ATC
- Athletic Trainer
- Apopka, FL
National Provider Identifier
1821665894
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 5095
- Practice address
- 1706 E Semoran Blvd Ste 107
Apopka, FL 32703-5610 - Phone
- (407) 880-7772
- NPI assigned
- Jun 8, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 5095 | FL | Primary |
Addresses
Primary practice location
1706 E Semoran Blvd Ste 107
Apopka, FL 32703-5610
Mailing address
1788 Hempel Ave
Windermere, FL 34786-8118
Phone (407) 808-3068
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5095 | FL | MD | Physical Rehabilitation Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623110400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623110400000",
"number": "1821665894",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1788 HEMPEL AVE",
"city": "WINDERMERE",
"state": "FL",
"postal_code": "347868118",
"telephone_number": "407-808-3068"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1706 E SEMORAN BLVD STE 107",
"city": "APOPKA",
"state": "FL",
"postal_code": "327035610",
"telephone_number": "407-880-7772"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIXNER",
"first_name": "JACK",
"credential": "MS, ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-06-08",
"last_updated": "2021-06-08",
"certification_date": "2021-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "FL",
"license": "5095",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Apopka, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.