Provider Demographics
NPI:1912369265
Name:DENISON, MICHAELA LARNED (MD)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:LARNED
Last Name:DENISON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:580 W 8TH ST
Mailing Address - Street 2:TOWER II, SUITE 6005
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-6533
Mailing Address - Country:US
Mailing Address - Phone:904-244-9905
Mailing Address - Fax:904-244-3455
Practice Address - Street 1:580 W 8TH ST
Practice Address - Street 2:TOWER II, SUITE 6005
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6533
Practice Address - Country:US
Practice Address - Phone:904-244-9905
Practice Address - Fax:904-244-3455
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-25
Last Update Date:2023-04-21
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Provider Licenses
StateLicense IDTaxonomies
FLME1376092084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry