Provider Demographics
NPI:1730133521
Name:FOREHAND, MICHAEL (ARNP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:FOREHAND
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2337 RB CARTER PKWY
Mailing Address - Street 2:
Mailing Address - City:BONIFAY
Mailing Address - State:FL
Mailing Address - Zip Code:32425-7321
Mailing Address - Country:US
Mailing Address - Phone:850-628-6232
Mailing Address - Fax:
Practice Address - Street 1:100 S MADISON ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5473
Practice Address - Country:US
Practice Address - Phone:229-498-1088
Practice Address - Fax:229-498-1066
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2892752363L00000X
GA214205363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263302700Medicaid
FLY0512ZMedicare ID - Type UnspecifiedARNP
FL263302700Medicaid