Provider Demographics
NPI:1821065780
Name:NIZAN, MICHAL (ARNP-C)
Entity Type:Individual
Prefix:
First Name:MICHAL
Middle Name:
Last Name:NIZAN
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12750 JUDY ST
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-8323
Mailing Address - Country:US
Mailing Address - Phone:352-567-2633
Mailing Address - Fax:352-567-2633
Practice Address - Street 1:12750 JUDY ST
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-8323
Practice Address - Country:US
Practice Address - Phone:352-567-2633
Practice Address - Fax:352-567-2633
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1927792363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304196400Medicaid
FLY0528AMedicare PIN
FLP50279Medicare UPIN