Provider Demographics
NPI:1417126418
Name:OWENS, MICHAEL VINCENT (ARNP, RNFA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:VINCENT
Last Name:OWENS
Suffix:
Gender:M
Credentials:ARNP, RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 W NEWBERRY RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2245
Mailing Address - Country:US
Mailing Address - Phone:352-336-6000
Mailing Address - Fax:352-332-0799
Practice Address - Street 1:4500 W NEWBERRY RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2245
Practice Address - Country:US
Practice Address - Phone:352-336-6000
Practice Address - Fax:352-336-6093
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2059552363LF0000X, 163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDA273ZMedicare PIN