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NPI Code Detail

MEDICARE: MICHELLE A PETTIT PAC

MEDICARE: MICHELLE A PETTIT PAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant0110004438VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114000676
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE A PETTIT PAC
Provider Business Mailing Address
First Line : PO BOX 4059
Second Line :
City : WAYNE
State : NJ
Zip : 07474-4059
Country : US
Telephone Number : 973-826-8291
Fax Number :
Provider Business Practice Location Address
First Line : 4215 EDGEWATER DR
Second Line :
City : ORLANDO
State : FL
Zip : 32804-2206
Country : US
Telephone Number : 973-826-8291
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2006
Last Update Date : 03/12/2021

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Directions to “ MICHELLE A PETTIT PAC” Practice Location

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