Provider Demographics
NPI:1669125332
Name:NIEDERMEYER, MICHELE (APRN)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:NIEDERMEYER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 N CLYDE MORRIS BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5532
Mailing Address - Country:US
Mailing Address - Phone:386-274-1004
Mailing Address - Fax:
Practice Address - Street 1:1717 N CLYDE MORRIS BLVD STE 130
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5532
Practice Address - Country:US
Practice Address - Phone:386-274-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11017779363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily