Individual
MS. GWENDOLYN BRUCH MICHAELMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
3001 W DR MARTIN LUTHER KING JR BLVD, TAMPA, FL 33607-6307
(813) 870-4000
Mailing address
2727 W DR MARTIN LUTHER KING JR BLVD, SUITE NUMBER 300, TAMPA, FL 33607-6383
(813) 874-5707
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9104166
FL
363AM0700X
Medical Physician Assistant
Q62542
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
292912100
—
FL
Enumeration date
03/22/2007
Last updated
06/30/2008
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