Provider Demographics
NPI:1760804132
Name:SCARBOROUGH, MICHELE (MSN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:
Last Name:SCARBOROUGH
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-7307
Mailing Address - Country:US
Mailing Address - Phone:478-787-4266
Mailing Address - Fax:
Practice Address - Street 1:770 WALNUT ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7307
Practice Address - Country:US
Practice Address - Phone:478-787-4266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-20
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN154220363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily