Provider Demographics
NPI:1801268875
Name:TARRY, MICHELLE H (ARNP)
Entity type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:H
Last Name:TARRY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:14690 SPRING HILL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-799-0046
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:13235 STATE ROAD 52 STE 102
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34669-2968
Practice Address - Country:US
Practice Address - Phone:727-378-8503
Practice Address - Fax:727-857-7807
Is Sole Proprietor?:No
Enumeration Date:2015-10-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9187162363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIN272YMedicare UPIN
FLIN272XMedicare PIN
FLIN272ZMedicare PIN