=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205125523
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELE GENEVIEVE AZZATI ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2011
-----------------------------------------------------
Last Update Date | 01/06/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1940 HARRISON AVE
-----------------------------------------------------
City | PANAMA CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32405-4542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-319-3905
-----------------------------------------------------
Fax | 786-464-9769
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 CABANA BLVD UNIT 3406
-----------------------------------------------------
City | PANAMA CITY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32407-4567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-319-3905
-----------------------------------------------------
Fax | 786-464-9769
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 2208662
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------