Provider Demographics
NPI:1013737014
Name:SIBILLE, MICHELLE PETRUCCO (FNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:PETRUCCO
Last Name:SIBILLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 MEDICAL CENTER BLVD STE 511
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3156
Mailing Address - Country:US
Mailing Address - Phone:504-349-6301
Mailing Address - Fax:
Practice Address - Street 1:1111 MEDICAL CENTER BLVD STE 511
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3156
Practice Address - Country:US
Practice Address - Phone:504-349-6301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA234526363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily