Provider Demographics
NPI:1497715924
Name:LIPMAN, MICHELE DIANE (ARNP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:DIANE
Last Name:LIPMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:DIANE
Other - Last Name:MORVILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1106 POMELO AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-8439
Mailing Address - Country:US
Mailing Address - Phone:941-320-1567
Mailing Address - Fax:941-960-2231
Practice Address - Street 1:10920 TECHNOLOGY TER
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34211-4930
Practice Address - Country:US
Practice Address - Phone:941-757-4820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1616662363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307885000Medicaid
FLY01JKOtherBCBS
FL307885000Medicaid
FLY01JKOtherBCBS
FLE6194XMedicare PIN