Individual
MRS. MICHELLE DIANE NICELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.- C.
Contact information
Practice address
3301 W GANDY BLVD, TAMPA, FL 33611-2931
(813) 925-1903
(813) 749-8370
Mailing address
5618 OSPREY PARK PL, LITHIA, FL 33547-3814
(813) 684-0300
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9100658
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000564500
—
CA
Enumeration date
12/06/2006
Last updated
10/20/2025
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