Healthcare Provider Details

I. General information

NPI: 1316347420
Provider Name (Legal Business Name): MICHELLE CATHERINE BLAIR N.N.P- B.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE CATHERINE HARRIS R.N.; A.R.N.P.

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 HICKORY ST
MELBOURNE FL
32901-3224
US

IV. Provider business mailing address

1350 HICKORY ST
MELBOURNE FL
32901-3224
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-2528
  • Fax: 407-303-2760
Mailing address:
  • Phone: 407-303-2528
  • Fax: 407-303-2760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN162
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAPRN2153732
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number930144
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: