Provider Demographics
NPI:1942031265
Name:MITSAKIS, STEFANO THEMIO
Entity type:Individual
Prefix:
First Name:STEFANO
Middle Name:THEMIO
Last Name:MITSAKIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 HIDDEN PALM CIR APT 204
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34747-2032
Mailing Address - Country:US
Mailing Address - Phone:617-501-4384
Mailing Address - Fax:
Practice Address - Street 1:1724 33RD ST STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-8858
Practice Address - Country:US
Practice Address - Phone:407-917-8553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11034523363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily