Healthcare Provider Details

I. General information

NPI: 1104560234
Provider Name (Legal Business Name): MICHELLE HEDRICK AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 ULMERTON RD
LARGO FL
33771-5003
US

IV. Provider business mailing address

5470 RIVERFRONT DR APT A
BRADENTON FL
34208-5249
US

V. Phone/Fax

Practice location:
  • Phone: 727-777-4540
  • Fax: 727-248-0432
Mailing address:
  • Phone: 219-707-9647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number11016308
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: