Individual
JESSIE L MICHAEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
2824 ENTERPRISE RD, ORANGE CITY, FL 32763-8428
(386) 774-7411
(386) 774-7412
Mailing address
PO BOX 102222, ATLANTA, GA 30368-2222
(239) 274-8200
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APRN11021559
FL
363LP2300X
Primary Care Nurse Practitioner
11021559
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115491600
—
FL
01
—
APRN11021559
STATE LICENSE
FL
Enumeration date
08/25/2022
Last updated
05/01/2023
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