Healthcare Provider Details

I. General information

NPI: 1922540319
Provider Name (Legal Business Name): MICHELLE RHODES REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20525 GRAND VISTA LN
TAMPA FL
33647-3456
US

IV. Provider business mailing address

20525 GRAND VISTA LN
TAMPA FL
33647-3456
US

V. Phone/Fax

Practice location:
  • Phone: 813-390-2206
  • Fax: 813-501-8837
Mailing address:
  • Phone: 813-390-2206
  • Fax: 813-501-8837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number3035192
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: