Provider Demographics
NPI:1346593613
Name:DUCKSTEIN, MICHELE (RN)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:DUCKSTEIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3955 WINDCHIME LN
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-3006
Mailing Address - Country:US
Mailing Address - Phone:863-701-9353
Mailing Address - Fax:
Practice Address - Street 1:3955 WINDCHIME LN
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33811-3006
Practice Address - Country:US
Practice Address - Phone:863-701-9353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP2261101YA0400X
FL9309366163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)