Provider Demographics
NPI:1275141814
Name:CARLSSON, MICHI CRISTINA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MICHI
Middle Name:CRISTINA
Last Name:CARLSSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:CRISTINA
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:231 SUN ISLE CIR UNIT 308
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-2728
Mailing Address - Country:US
Mailing Address - Phone:305-609-3364
Mailing Address - Fax:
Practice Address - Street 1:231 SUN ISLE CIR UNIT 308
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-2728
Practice Address - Country:US
Practice Address - Phone:305-609-3364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113374363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant