Provider Demographics
NPI:1669455242
Name:GARCIA, MICHELE MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:MARIE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:M
Other - Last Name:MCNAUGHTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2420 WEST DIVISION STREET
Mailing Address - Street 2:CVS MINUTECLINIC
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-3926
Mailing Address - Country:US
Mailing Address - Phone:320-253-5366
Mailing Address - Fax:
Practice Address - Street 1:2420 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-3926
Practice Address - Country:US
Practice Address - Phone:320-253-5366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9371207Q00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN413292100Medicaid
MN413292100Medicaid
MN413292100Medicaid