Provider Demographics
NPI:1952454563
Name:LAGUENS, MICHELLE VORCE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:VORCE
Last Name:LAGUENS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:DYAN
Other - Last Name:VORCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:356 SPANISH CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-6174
Mailing Address - Country:US
Mailing Address - Phone:240-346-7073
Mailing Address - Fax:
Practice Address - Street 1:14011 BEACH BLVD STE 120
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-1695
Practice Address - Country:US
Practice Address - Phone:904-282-6331
Practice Address - Fax:904-619-1080
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9112862363AM0700X, 363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical