Healthcare Provider Details

I. General information

NPI: 1528497518
Provider Name (Legal Business Name): MICHELLE SARAH FLETCHER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE SARAH RUBIN ARNP

II. Dates (important events)

Enumeration Date: 11/11/2013
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 DR PHILLIPS BLVD STE 10
ORLANDO FL
32819
US

IV. Provider business mailing address

7575 DR PHILLIPS BLVD STE 10
ORLANDO FL
32819-7221
US

V. Phone/Fax

Practice location:
  • Phone: 407-377-5438
  • Fax: 407-386-6188
Mailing address:
  • Phone: 407-377-5438
  • Fax: 407-386-6188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9298322
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: