Individual provider Active NPI

Carson Wiles Mitchell

  • Family Nurse Practitioner
  • Winter Haven, FL
National Provider Identifier
1962364984
Registry record updated Nov 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN11042691 Issued in FL
Practice address
1450 6TH St SE
Winter Haven, FL 33880-4505
Phone
(863) 293-2147
NPI assigned
Nov 27, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN11042691 FL Primary

Addresses

Primary practice location

1450 6TH St SE
Winter Haven, FL 33880-4505

Mailing address

1450 6TH St SE
Winter Haven, FL 33880-4505

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260105000132 FL Practitioner - Nurse Practitioner 5799271391 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1450 6TH St SE
Winter Haven, FL 33880-4505

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN11042691FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
K Wade Foster MD PA CurrentSince Dec 1, 2025 Accepting new patients

Locations

24880 Burnt Pine Dr
Ste 1
Bonita Springs, FL 34134

421 Linden Ln
Lake Wales, FL 33853
Phone (863) 293-2147

1450 6th St SE
Winter Haven, FL 33880
Phone (863) 293-2147

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1764201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764201600000",
    "number": "1962364984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 6TH ST SE",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338804505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 6TH ST SE",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338804505",
            "telephone_number": "863-293-2147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "CARSON",
        "middle_name": "WILES",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-11-27",
        "last_updated": "2025-11-27",
        "certification_date": "2025-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN11042691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winter Haven, FL

Sources for this page

Verify at the official NPI Registry.