Provider Demographics
NPI:1336649649
Name:WOJCIECHOWSKI, MICHELLE (ARNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:WOJCIECHOWSKI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 TN 73
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:34221-4737
Mailing Address - Country:US
Mailing Address - Phone:607-427-3211
Mailing Address - Fax:
Practice Address - Street 1:15061 SE 103RD AVE
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491
Practice Address - Country:US
Practice Address - Phone:607-427-3211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-14
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9331613363LF0000X
CT149817363LP0808X
FLAPRN9331613363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily