Provider Demographics
NPI:1659955516
Name:LUGO, MICHELLE MARIE (DNP, APRN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:LUGO
Suffix:
Gender:F
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 N HABANA AVE STE 702
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7122
Mailing Address - Country:US
Mailing Address - Phone:813-872-0613
Mailing Address - Fax:727-499-7839
Practice Address - Street 1:4700 N HABANA AVE STE 702
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7122
Practice Address - Country:US
Practice Address - Phone:813-872-0613
Practice Address - Fax:727-499-7839
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11007869363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner