Healthcare Provider Details

I. General information

NPI: 1487745345
Provider Name (Legal Business Name): MICHELLE L. LIDDY APRN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2671 HIGHWAY 70
MANASQUAN NJ
08736-2605
US

IV. Provider business mailing address

330 E HIBISCUS BLVD
MELBOURNE FL
32901-3155
US

V. Phone/Fax

Practice location:
  • Phone: 732-528-6999
  • Fax: 732-528-3397
Mailing address:
  • Phone: 321-724-2229
  • Fax: 321-728-6688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9483866
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN9483866
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number25ME00029900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: