Healthcare Provider Details

I. General information

NPI: 1942718150
Provider Name (Legal Business Name): MICHELLE R PAGEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE R HILL

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14029 W NEWBERRY RD UNIT 60
JONESVILLE FL
32669-2792
US

IV. Provider business mailing address

154 NW 257TH ST
NEWBERRY FL
32669-4183
US

V. Phone/Fax

Practice location:
  • Phone: 352-872-5930
  • Fax: 352-872-5932
Mailing address:
  • Phone: 352-213-6332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH10872
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: