Individual
MICHELLE DETERDING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 TAMPA GENERAL CIR, TAMPA, FL 33606-3571
(812) 844-7000
Mailing address
1312 ALLEN ST, OWENSBORO, KY 42303-3033
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041382122
IL
163W00000X
Registered Nurse
1147870
KY
367500000X
Certified Registered Nurse Anesthetist
Primary
11006456
FL
Other
Enumeration date
11/14/2019
Last updated
03/10/2020
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