Provider Demographics
NPI:1932288982
Name:BOONE, MICHELLE ANNE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ANNE
Last Name:BOONE
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 1:5626 BAY SIDE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-4045
Mailing Address - Country:US
Mailing Address - Phone:407-234-5539
Mailing Address - Fax:
Practice Address - Street 1:7450 DR PHILLIPS BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5119
Practice Address - Country:US
Practice Address - Phone:407-569-2639
Practice Address - Fax:407-745-5593
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1002702363L00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL300642500Medicaid
P07590001Medicare UPIN