Healthcare Provider Details

I. General information

NPI: 1336649649
Provider Name (Legal Business Name): MICHELLE WOJCIECHOWSKI ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2018
Last Update Date: 03/11/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15061 SE 103RD AVE
SUMMERFIELD FL
34491
US

IV. Provider business mailing address

1000 TN 73
NEWPORT TN
34221-4737
US

V. Phone/Fax

Practice location:
  • Phone: 607-427-3211
  • Fax:
Mailing address:
  • Phone: 607-427-3211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9331613
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number149817
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN9331613
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: