Provider Demographics
NPI:1114057809
Name:PAPANIA, MICHAEL JOSEPH (MSN)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:PAPANIA
Suffix:
Gender:M
Credentials:MSN
Other - Prefix:MRS
Other - First Name:PATTI
Other - Middle Name:LYNN
Other - Last Name:PAPANIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3000 PAPANIA LN
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-5849
Mailing Address - Country:US
Mailing Address - Phone:228-864-6759
Mailing Address - Fax:
Practice Address - Street 1:257 DAVIS AVE STE A
Practice Address - Street 2:
Practice Address - City:PASS CHRISTIAN
Practice Address - State:MS
Practice Address - Zip Code:39571-4541
Practice Address - Country:US
Practice Address - Phone:228-864-4818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR5588822363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08179254Medicaid
MSS70986Medicare UPIN