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General NPI Number Information
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NPI Number | 1134596802
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Entity Type | Individual
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Provider Name | MICHELLE LYNN PENDLETON APRN
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Gender | Female
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Dates
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Enumeration Date | 08/28/2015
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Last Update Date | 05/07/2024
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Provider Practice Location Address
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Address Line | 851042 US HIGHWAY 17
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City | YULEE
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State | FL
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Zip | 32097-2845
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Country | US
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Telephone | 904-225-3824
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Fax | 904-390-7440
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Provider Business Mailing Address
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Address Line | PO BOX 746638
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City | ATLANTA
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State | GA
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Zip | 30374-6638
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Country | US
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Telephone | 904-202-1032
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Fax | 904-376-4107
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN280179
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9238670
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN9238670
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License Number State | FL
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