Provider Demographics
NPI:1124601117
Name:GULIZIO, MICHELLE LEE (APRN)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:LEE
Last Name:GULIZIO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4228 SILVER STAR DR
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34609-0381
Mailing Address - Country:US
Mailing Address - Phone:352-238-9822
Mailing Address - Fax:
Practice Address - Street 1:4228 SILVER STAR DR
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34609-0381
Practice Address - Country:US
Practice Address - Phone:352-238-9822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11011928261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy