=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457377095
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE A JN-BAPTISTE PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2006
-----------------------------------------------------
Last Update Date | 11/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2001 W BLUE HERON BLVD
-----------------------------------------------------
City | RIVIERA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33404-5003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-841-3500
-----------------------------------------------------
Fax | 561-844-3342
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10521 SW VILLAGE CENTER DR STE 201
-----------------------------------------------------
City | PORT ST LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34987-1930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 728-737-1147
-----------------------------------------------------
Fax | 772-873-7115
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA9101608
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------