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General NPI Number Information
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NPI Number | 1487466074
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Entity Type | Individual
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Provider Name | MICHELLE EVERLY PHILLIPS
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Gender | Female
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Dates
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Enumeration Date | 01/22/2025
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 4655 SALISBURY RD STE 220
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City | JACKSONVILLE
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State | FL
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Zip | 32256-0959
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Country | US
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Telephone | 904-570-9404
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Fax | 904-900-2224
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Provider Business Mailing Address
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Address Line | 36644 DYAL RD
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City | CALLAHAN
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State | FL
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Zip | 32011-3483
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Country | US
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Telephone | 904-338-6948
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ARNP11037283
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License Number State | FL
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