Provider Demographics
NPI:1275925109
Name:PIERRE, MICHAELLE (AA-C)
Entity Type:Individual
Prefix:
First Name:MICHAELLE
Middle Name:
Last Name:PIERRE
Suffix:
Gender:F
Credentials:AA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 W LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-4552
Mailing Address - Country:US
Mailing Address - Phone:727-230-1576
Mailing Address - Fax:
Practice Address - Street 1:4805 W LAUREL ST STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-4552
Practice Address - Country:US
Practice Address - Phone:727-230-1576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1000-00587367H00000X
1870367H00000X
FLAA392367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1275925109Medicaid
NCQ49758AMedicare PIN