Provider Demographics
NPI:1184206542
Name:PEOPLES, MICHELLE TERRELL
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:TERRELL
Last Name:PEOPLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2329 JOHNSON AVE LOT 35
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-5935
Mailing Address - Country:US
Mailing Address - Phone:850-252-7549
Mailing Address - Fax:
Practice Address - Street 1:2329 JOHNSON AVE LOT 35
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-5935
Practice Address - Country:US
Practice Address - Phone:850-252-7549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL163424376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty