Provider Demographics
NPI:1083712665
Name:MORGAN, MICHELLE DENISE (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:DENISE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13000 BRUCE B DOWNS BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-4745
Mailing Address - Country:US
Mailing Address - Phone:727-869-4100
Mailing Address - Fax:
Practice Address - Street 1:2804 W MARC KNIGHTON CT
Practice Address - Street 2:SUITE A
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-6300
Practice Address - Country:US
Practice Address - Phone:352-746-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO945207Q00000X
GA051694207Q00000X
NY197975207Q00000X
FLOS12639207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01678404Medicaid
NY01678404Medicaid
NYG36812Medicare UPIN