Healthcare Provider Details

I. General information

NPI: 1659404465
Provider Name (Legal Business Name): MICHELLE RENEE ELIE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE ELIE

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 10/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 CENTRAL AVE E
WINTER HAVEN FL
33880-3051
US

IV. Provider business mailing address

409 CENTRAL AVE E
WINTER HAVEN FL
33880-3051
US

V. Phone/Fax

Practice location:
  • Phone: 863-293-2144
  • Fax: 863-293-3732
Mailing address:
  • Phone: 863-293-2144
  • Fax: 863-293-3732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9207564
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: