Provider Demographics
NPI:1780181149
Name:BORELAND, MICHELLE SCHEVONNE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SCHEVONNE
Last Name:BORELAND
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8140 NW 47TH CT
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33351-5630
Mailing Address - Country:US
Mailing Address - Phone:954-554-6278
Mailing Address - Fax:
Practice Address - Street 1:8140 NW 47TH CT
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33351-5630
Practice Address - Country:US
Practice Address - Phone:954-554-6278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL13028310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility