Healthcare Provider Details

I. General information

NPI: 1891350047
Provider Name (Legal Business Name): MICHELLE ANN MARIE AQUINO RAPANUT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE ANN MARIE ARENAS AQUINO

II. Dates (important events)

Enumeration Date: 05/03/2019
Last Update Date: 05/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 45TH ST
MANGONIA PARK FL
33407-2413
US

IV. Provider business mailing address

901 45TH ST
MANGONIA PARK FL
33407-2413
US

V. Phone/Fax

Practice location:
  • Phone: 561-844-6300
  • Fax:
Mailing address:
  • Phone: 561-844-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License NumberTN45987
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number244255
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: