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General NPI Number Information
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NPI Number | 1316648868
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Entity Type | Individual
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Provider Name | MICHELLE G ETHERIDGE
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Gender | Female
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Dates
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Enumeration Date | 03/13/2023
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Last Update Date | 04/16/2023
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Provider Practice Location Address
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Address Line | 5150 BELFORT RD BLDG 400
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City | JACKSONVILLE
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State | FL
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Zip | 32256-6026
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Country | US
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Telephone | 904-580-4730
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Fax |
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Provider Business Mailing Address
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Address Line | 2120 CHEROKEE COVE TRL
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City | JACKSONVILLE
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State | FL
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Zip | 32221-4930
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Country | US
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Telephone | 720-383-0469
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11025741
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License Number State | FL
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