Healthcare Provider Details

I. General information

NPI: 1164385217
Provider Name (Legal Business Name): MICHELLE DENISE RUTILIUS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 W AMELIA ST
ORLANDO FL
32801-1128
US

IV. Provider business mailing address

445 W AMELIA ST
ORLANDO FL
32801-1128
US

V. Phone/Fax

Practice location:
  • Phone: 407-317-3200
  • Fax:
Mailing address:
  • Phone: 407-317-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11004212
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: