Provider Demographics
NPI:1295877447
Name:LINGO, MICHELE RENEE (CPHT)
Entity type:Individual
Prefix:MISS
First Name:MICHELE
Middle Name:RENEE
Last Name:LINGO
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:MRS
Other - First Name:MICHELE
Other - Middle Name:RENEE
Other - Last Name:ANDRZEJCZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPHT
Mailing Address - Street 1:25946 HOLIDAY DR
Mailing Address - Street 2:
Mailing Address - City:ASTOR
Mailing Address - State:FL
Mailing Address - Zip Code:32102-3602
Mailing Address - Country:US
Mailing Address - Phone:352-978-0253
Mailing Address - Fax:
Practice Address - Street 1:2 E MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-3417
Practice Address - Country:US
Practice Address - Phone:352-357-4341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2501-0103-0350-872183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician