Provider Demographics
NPI:1346867207
Name:ATTAR, MICHELLE IVY (APRN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:IVY
Last Name:ATTAR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9685 LAKE NONA VILLAGE PL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7320
Mailing Address - Country:US
Mailing Address - Phone:407-627-1148
Mailing Address - Fax:
Practice Address - Street 1:9685 LAKE NONA VILLAGE PL STE 205
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7322
Practice Address - Country:US
Practice Address - Phone:407-627-1148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11006853363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily