Provider Demographics
NPI:1891406104
Name:WOZNICKI, MICHELLE M (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:WOZNICKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4345 NW 26TH DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-1634
Mailing Address - Country:US
Mailing Address - Phone:321-626-9876
Mailing Address - Fax:
Practice Address - Street 1:4345 NW 26TH DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-1634
Practice Address - Country:US
Practice Address - Phone:321-626-9876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9115423363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant