Provider Demographics
NPI:1396938767
Name:CORTES, MICHELLE CRISTINA (PA)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:CRISTINA
Last Name:CORTES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10025 CLEARY BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1000
Mailing Address - Country:US
Mailing Address - Phone:954-382-1550
Mailing Address - Fax:954-382-1250
Practice Address - Street 1:10025 CLEARY BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1000
Practice Address - Country:US
Practice Address - Phone:954-382-1550
Practice Address - Fax:954-382-1250
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9103540363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant