Healthcare Provider Details

I. General information

NPI: 1891406104
Provider Name (Legal Business Name): MICHELLE M WOZNICKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 SW COLLEGE RD
OCALA FL
34474-4441
US

IV. Provider business mailing address

3708 SW COLLEGE RD
OCALA FL
34474-4441
US

V. Phone/Fax

Practice location:
  • Phone: 352-401-8401
  • Fax:
Mailing address:
  • Phone: 352-401-8401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9115423
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: