Provider Demographics
NPI:1790110039
Name:CONKLIN, MICHELLE B (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:B
Last Name:CONKLIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11580 MELLOW CT
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-9125
Mailing Address - Country:US
Mailing Address - Phone:561-719-2223
Mailing Address - Fax:888-939-4244
Practice Address - Street 1:11580 MELLOW CT
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-9125
Practice Address - Country:US
Practice Address - Phone:561-719-2223
Practice Address - Fax:888-939-4244
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9214512363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020856400Medicaid