Provider Demographics
NPI:1003139395
Name:SHINHAM, MICHELLE GIBSON (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:GIBSON
Last Name:SHINHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:DENISE
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4600 SW 46TH CT
Mailing Address - Street 2:SUITE 150
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-5708
Mailing Address - Country:US
Mailing Address - Phone:352-369-5999
Mailing Address - Fax:352-629-4227
Practice Address - Street 1:4600 SW 46TH CT
Practice Address - Street 2:SUITE 150
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-5708
Practice Address - Country:US
Practice Address - Phone:352-369-5999
Practice Address - Fax:352-629-4227
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9105348363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant