Provider Demographics
NPI:1669115960
Name:MONTINI, MICHELLE PEARL
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:PEARL
Last Name:MONTINI
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 1:16750 CR 33
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:FL
Mailing Address - Zip Code:34736
Mailing Address - Country:US
Mailing Address - Phone:989-944-5850
Mailing Address - Fax:
Practice Address - Street 1:16750 CR 33
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:FL
Practice Address - Zip Code:34736
Practice Address - Country:US
Practice Address - Phone:989-944-5850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11018741363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily