Provider Demographics
NPI:1457377095
Name:JN-BAPTISTE, MICHELLE A (PA-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:JN-BAPTISTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10521 SW VILLAGE CENTER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-1930
Mailing Address - Country:US
Mailing Address - Phone:728-737-1147
Mailing Address - Fax:772-873-7115
Practice Address - Street 1:10521 SW VILLAGE CENTER DR STE 201
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-1930
Practice Address - Country:US
Practice Address - Phone:772-873-7114
Practice Address - Fax:772-873-7115
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101608363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE8040OtherMEDICARE
FL291539100Medicaid
FLE8040OtherMEDICARE