Healthcare Provider Details

I. General information

NPI: 1720850712
Provider Name (Legal Business Name): MICHALONA SCIPPIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4255 SW CAMBRIDGE GLN
LAKE CITY FL
32024-3431
US

IV. Provider business mailing address

PO BOX 2666
LAKE CITY FL
32056-2666
US

V. Phone/Fax

Practice location:
  • Phone: 386-389-6549
  • Fax: 855-706-2046
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11029008
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: