Provider Demographics
NPI:1689630055
Name:CAMACHO, MICHELLE (NP, APN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:NP, APN
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:COLLAZO-CAMACHO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PNNP, RN, C
Mailing Address - Street 1:770 NORTHPOINT PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-1901
Mailing Address - Country:US
Mailing Address - Phone:561-802-5357
Mailing Address - Fax:561-275-7547
Practice Address - Street 1:927 45TH ST STE 103
Practice Address - Street 2:
Practice Address - City:MANGONIA PARK
Practice Address - State:FL
Practice Address - Zip Code:33407-2450
Practice Address - Country:US
Practice Address - Phone:561-841-0911
Practice Address - Fax:561-630-8007
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2021-02-25
Deactivation Date:2007-10-29
Deactivation Code:
Reactivation Date:2007-12-03
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00058000363LP1700X
FLARNP9429883363LP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP1700XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPerinatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0036111Medicaid
FL101042200Medicaid
NJ0036111Medicaid