TRACIE LEDORA MITCHEM-GREEN (NPI# 1942321575) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942321575 |
| Entity Type | Individual |
| Full Name | TRACIE LEDORA MITCHEM-GREEN |
| Credential | F.N.P |
| Practice Address |
295 Nw Commons Loop # 115-105 Lake City FL 32055-7721 |
| Practice Telephone | 8033817690 |
| Mailing Telephone | 8033817690 |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2018-05-10 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | 2981 | SC | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
9304575 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
342892 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
ARNP9304575 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
2981 | SC | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
295 NW COMMONS LOOP # 115-105 |
| City | LAKE CITY |
| State | FL |
| Zip Code | 32055-7721 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114439510 | Melissa Fay Peters | Nurse Practitioner | 5085 West Us Highway 90, Lake City, FL 32055 | 2017-10-26 |
| 1851801765 | Stephanie Jo Nogle | Occupational Therapist | Brooks Americare: 4251 Nw American Ln, #103, Lake City, FL 32055 | 2017-10-05 |
| 1831617273 | Erica Mayo | Pharmacist | 4846 Nw Lake Jeffery Rd., Lake City, FL 32055 | 2017-09-06 |
| 1144759333 | Jerry Hamilton Cheesman | Dentist | 217 Ne Franklin Sreet, Lake City, FL 32055 | 2017-06-09 |
| 1487183745 | Joshua Allore | Dentist | 2970 W Us Highway 90., Lake City, FL 32055 | 2017-06-08 |
| 1497298418 | Careing Hands | Preferred Provider Organization | 1471nw Queen Rd, Lakecity, FL 32055 | 2016-11-22 |
| 1881148278 | Corniqueca Stewart-simmons | Nurse Practitioner | 340 Nw Commerce Drive, Lake City, FL 32055 | 2016-08-15 |
| 1164809141 | Latasha Harten-jones | Licensed Practical Nurse | 443 Ne Sims Dr, Lake City, FL 32055 | 2015-04-29 |
| 1154716447 | Lindsey Morton | Counselor | 219 Se Baya Avenue, Lake City, FL 32055 | 2015-04-02 |
| 1124439351 | Tynette Jordan | Counselor | 708 N.w Wilson St., Lake City, FL 32055 | 2014-05-09 |
| Find all providers in zip 32055 | ||||
| Taxonomy Code | 363LP2300X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962954222 | Marisol Isabel Santamarina | Nurse Practitioner | 3239 Nw York Dr, Lake City, FL 32055-8641 | 2016-11-02 |
| 1720320740 | Jon Kennon Peters | Nurse Practitioner | 148 Sauls St Ste E, Lake City, SC 29560-2677 | 2013-03-18 |
| 1174063127 | Nicole Polbos | Nurse Practitioner | 1283 Sw State Road 47, Suite 104, Lake City, FL 32025-0489 | 2017-02-24 |
| 1730630880 | Rene Walberto Zambrana | Nurse Practitioner | 751 Se Sycamore Ter, Lake City, FL 32025-6216 | 2016-10-24 |
| 1861429839 | Donna J Caldwell | Nurse Practitioner | 217 Ne Franklin St, Lake City, FL 32055-2981 | 2006-06-27 |
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| 1518565894 | Karen Giselle Reyes | Nurse Practitioner | 4563 Perth Rd, West Palm Beach, FL 33415-2811 | 2020-10-09 |
| 1265039424 | Catherine Dettelbach Lake | Nurse Practitioner | 3411 Shenandoah Dr W, Orange Park, FL 32073-6631 | 2020-10-01 |
| 1417562877 | Victoria Ann Jacobs | Nurse Practitioner | 3605 Lithia Ridge Blvd, Valrico, FL 33596-6482 | 2020-09-12 |
| 1760096135 | Conciergenp | Nurse Practitioner | 1221 S 23rd Ave, Hollywood, FL 33020-5912 | 2020-09-03 |
| 1649881434 | Dr Jose A Rivera LLC | Nurse Practitioner | 110 W Citrus St, Altamonte Springs, FL 32714-2502 | 2020-08-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.