Provider Demographics
NPI:1205250719
Name:ANDERSON, MICHELE L (APRN, CNM)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:LEE
Other - Last Name:HEFLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:407-960-2112
Mailing Address - Fax:407-960-7024
Practice Address - Street 1:2035 GLENWOOD DR
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3307
Practice Address - Country:US
Practice Address - Phone:407-960-2112
Practice Address - Fax:407-960-7024
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN3167932363LW0102X, 363LX0001X, 367A00000X
FLARNP3167932363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010584100Medicaid
FLNP392OtherMEDICARE HF