Provider Demographics
NPI:1831431121
Name:FERGUSON, MICHELLE (APRN, DNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:APRN, DNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP,PNP
Mailing Address - Street 1:900 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3920
Mailing Address - Country:US
Mailing Address - Phone:954-741-4280
Mailing Address - Fax:954-741-4912
Practice Address - Street 1:4279 NW 88TH AVE
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6044
Practice Address - Country:US
Practice Address - Phone:954-741-4280
Practice Address - Fax:954-741-4912
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9173533363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016082600Medicaid