Provider Demographics
NPI:1619230331
Name:DULZAIDES, MICHELLE LYNN (ARNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:DULZAIDES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:JANDURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5900 LAKE ELLENOR DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-4618
Mailing Address - Country:US
Mailing Address - Phone:407-352-6968
Mailing Address - Fax:407-352-2547
Practice Address - Street 1:5900 LAKE ELLENOR DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4618
Practice Address - Country:US
Practice Address - Phone:407-352-6968
Practice Address - Fax:407-352-2547
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN2237122363LA2200X
FLARNP2237122363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005966100Medicaid
FLGG659ZMedicare PIN