Healthcare Provider Details

I. General information

NPI: 1104277797
Provider Name (Legal Business Name): MICHELE OWASKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2016
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11030 RCA CENTER DR SUITE 3015
PALM BEACH GARDENS FL
33410-4276
US

IV. Provider business mailing address

11030 RCA CENTER DR SUITE 3015
PALM BEACH GARDENS FL
33410-4276
US

V. Phone/Fax

Practice location:
  • Phone: 561-776-7041
  • Fax:
Mailing address:
  • Phone: 561-776-7041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9109025
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: