MEDICARE: MICHELE RENEE PEARSON APRN-PMH, BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN11035456	FL

General Provider Information

NPI Number	:	1043037138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE RENEE PEARSON APRN-PMH, BC

Provider Business Mailing Address
First Line	:	5649 SANDSTONE DR
Second Line	:
City	:	PACE
State	:	FL
Zip	:	32571-8500
Country	:	US
Telephone Number	:	601-479-9089
Fax Number	:

Provider Business Practice Location Address
First Line	:	1115 E GONZALEZ ST
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32503-6050
Country	:	US
Telephone Number	:	239-690-6906
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2024
Last Update Date	:	12/12/2024

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