Provider Demographics
NPI:1376830018
Name:WILCOX, MICHELE RENEE (APRN)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:RENEE
Last Name:WILCOX
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:RENEE
Other - Last Name:BYRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP
Mailing Address - Street 1:2660 W FAIRBANKS AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-3385
Mailing Address - Country:US
Mailing Address - Phone:407-898-2767
Mailing Address - Fax:
Practice Address - Street 1:1616 RIGGINS RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5316
Practice Address - Country:US
Practice Address - Phone:407-898-2767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11005895363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3091Medicaid
SCNP3091Medicaid