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General NPI Number Information
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NPI Number | 1659252518
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Entity Type | Individual
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Provider Name | MICHELLE CRISOSTOMO CANTRELL RN
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Gender | Female
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Dates
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Enumeration Date | 09/09/2025
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 1621 TENNESSEE AVE STE 300
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City | LYNN HAVEN
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State | FL
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Zip | 32444-3604
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Country | US
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Telephone | 850-872-0774
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Fax |
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Provider Business Mailing Address
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Address Line | 1104 DISCOVERY LOOP N
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City | PANAMA CITY
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State | FL
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Zip | 32405-2955
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Country | US
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Telephone | 904-910-1260
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN11042311
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9654754
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License Number State | FL
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