Provider Demographics
NPI:1518508399
Name:EAKIN, MICHAELENE A (NP-C)
Entity Type:Individual
Prefix:
First Name:MICHAELENE
Middle Name:A
Last Name:EAKIN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 LINDA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-3820
Mailing Address - Country:US
Mailing Address - Phone:386-804-1449
Mailing Address - Fax:
Practice Address - Street 1:226 LINDA VISTA ST
Practice Address - Street 2:
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-3820
Practice Address - Country:US
Practice Address - Phone:386-804-1449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9348669363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily