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General NPI Number Information
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NPI Number | 1457326472
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Entity Type | Individual
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Provider Name | MICHELE ST MARTIN HARGREAVES MD
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Gender | Female
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Dates
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Enumeration Date | 02/22/2006
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Last Update Date | 11/07/2016
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Provider Practice Location Address
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Address Line | 4203 BELFORT RD STE 340
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City | JACKSONVILLE
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State | FL
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Zip | 32216-1409
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Country | US
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Telephone | 904-880-0911
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Fax | 904-880-9388
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Provider Business Mailing Address
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Address Line | 11945 SAN JOSE BLVD SUITE 300
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City | JACKSONVILLE
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State | FL
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Zip | 32223-1613
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Country | US
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Telephone | 904-396-1725
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Fax | 904-399-1717
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MD425320
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | ME98473
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207YX0901X
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Taxonomy Name | Otology & Neurotology Physician
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License Number | ME98473
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License Number State | FL
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