Provider Demographics
NPI:1295057719
Name:PEDULLA, MICHELE E (ARNP)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:E
Last Name:PEDULLA
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 1:1802 CLEARBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-1429
Mailing Address - Country:US
Mailing Address - Phone:727-849-2535
Mailing Address - Fax:727-849-7157
Practice Address - Street 1:5411 GRAND BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4010
Practice Address - Country:US
Practice Address - Phone:727-849-2535
Practice Address - Fax:727-849-7157
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1658012363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306096900Medicaid
FL306096900Medicaid