Provider Demographics
NPI:1972177996
Name:WORTHEN, MICHELLE DOZIER (APRN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DOZIER
Last Name:WORTHEN
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:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:2351 PHILLIPS RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5333
Practice Address - Country:US
Practice Address - Phone:850-877-8166
Practice Address - Fax:850-877-0431
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-14
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH085681-23363LF0000X
FL11007943363LF0000X
FLAPRN11038895363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily