Healthcare Provider Details

I. General information

NPI: 1245732239
Provider Name (Legal Business Name): MICHELE GREENE VUOLO NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7409 SKINNER RD
PANAMA CITY FL
32404-9113
US

IV. Provider business mailing address

2460 OLD MOULTRIE RD STE 1
ST AUGUSTINE FL
32086-4198
US

V. Phone/Fax

Practice location:
  • Phone: 850-867-3014
  • Fax:
Mailing address:
  • Phone: 904-293-0299
  • Fax: 904-293-0299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF02180320
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9338347
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: