Healthcare Provider Details

I. General information

NPI: 1972198158
Provider Name (Legal Business Name): MICHELLE M JANOSSY PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 HARRISON ST
GREEN CV SPGS FL
32043-2721
US

IV. Provider business mailing address

306 HARRISON ST
GREEN CV SPGS FL
32043-2721
US

V. Phone/Fax

Practice location:
  • Phone: 904-814-0805
  • Fax:
Mailing address:
  • Phone: 904-814-0805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11011005
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: