Individual
MICHELLE LYNN HERRERO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1536 N JEFFERSON ST, JACKSONVILLE, FL 32209-6525
(904) 475-5800
Mailing address
PO BOX 44008, PROVIDER ENROLLMENT, JACKSONVILLE, FL 32231-4008
(904) 244-3660
(904) 244-3425
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
TRN12460
FL
2085R0202X
Diagnostic Radiology Physician
Primary
ME115494
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003134310A
—
GA
05
—
008782900
—
FL
01
—
14Q2U
BCBS
FL
Enumeration date
06/30/2008
Last updated
05/14/2014
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