Provider Demographics
NPI:1295123255
Name:HARSH, MICHELLE COLLEEN (ARNP)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:COLLEEN
Last Name:HARSH
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 1:4701 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-2332
Mailing Address - Country:US
Mailing Address - Phone:954-683-5456
Mailing Address - Fax:
Practice Address - Street 1:660 GLADES RD STE 340
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6468
Practice Address - Country:US
Practice Address - Phone:561-394-9292
Practice Address - Fax:561-394-3819
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-29
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9199835363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014755500Medicaid