Provider Demographics
NPI:1851940613
Name:SEVICK, MICHAEL LEON (FNP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEON
Last Name:SEVICK
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 SUNCHASE CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-0527
Mailing Address - Country:US
Mailing Address - Phone:904-300-5982
Mailing Address - Fax:
Practice Address - Street 1:165 WELLS RD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-3035
Practice Address - Country:US
Practice Address - Phone:904-269-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11003365363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily