Active NPI
Erica Nicole Mitchell
- Contractor
- Coconut Creek, FL
National Provider Identifier
1841500493
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- TK916702
- Practice address
- 6800 NW 39TH Ave. Lot 486
Coconut Creek, FL 33073 - Phone
- (740) 205-7315
- NPI assigned
- Oct 18, 2010
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Contractor | 171W00000X | TK916702 | OH | Primary |
Addresses
Primary practice location
6800 NW 39TH Ave. Lot 486
Coconut Creek, FL 33073
Mailing address
6800 NW 39TH Ave. Lot 486
Coconut Creek, FL 33073
Phone (740) 205-7315
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2830299 | Medicaid | OH |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TK916702 | OH | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1287360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1287360000000",
"number": "1841500493",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6800 NW 39TH AVE. LOT 486",
"city": "COCONUT CREEK",
"state": "FL",
"postal_code": "33073",
"telephone_number": "740-205-7315"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6800 NW 39TH AVE. LOT 486",
"city": "COCONUT CREEK",
"state": "FL",
"postal_code": "33073",
"telephone_number": "740-205-7315"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITCHELL",
"first_name": "ERICA",
"middle_name": "NICOLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-10-18",
"last_updated": "2010-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "OH",
"license": "TK916702",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2830299",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Coconut Creek, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.