Provider Demographics
NPI:1649578535
Name:BAECHLE, MICHELLE LYNN
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:BAECHLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 WESTON RD , SUITE 220
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1912
Mailing Address - Country:US
Mailing Address - Phone:954-384-6262
Mailing Address - Fax:954-384-1202
Practice Address - Street 1:1040 WESTON RD STE 220
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-1912
Practice Address - Country:US
Practice Address - Phone:954-384-6262
Practice Address - Fax:954-384-1202
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105603363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant