Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | ARNP1968192 | FL |
NPI | 1053514224 |
---|---|
Provider Name | Mrs. Michelle Helene Cormier-Boeckle |
First Address | Tampa, FL 33626 |
Second Address | Plant City, FL 33563-4303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2007 |
Last Update Date | 09/07/2007 |