Provider Demographics
NPI:1962668301
Name:CARLOS, MICHELLE L (FNP-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:CARLOS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 MEDICAL ARTS BLVD STE 114
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46011-3442
Mailing Address - Country:US
Mailing Address - Phone:765-298-4545
Mailing Address - Fax:765-298-4945
Practice Address - Street 1:1210 MEDICAL ARTS BLVD STE 114
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-3442
Practice Address - Country:US
Practice Address - Phone:765-298-4545
Practice Address - Fax:765-298-4945
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002701A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200985700Medicaid
IN200985700Medicaid
IN232230MMMMMedicare UPIN