MEDICARE: MICHELLE GORDON FNP-C

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
1	363L00000X	Nurse Practitioner	325259	AZ

General Provider Information

NPI Number	:	1255227591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE GORDON FNP-C

Provider Business Mailing Address
First Line	:	14961 W BELL RD STE 100
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374-3203
Country	:	US
Telephone Number	:	623-439-5176
Fax Number	:

Provider Business Practice Location Address
First Line	:	14961 W BELL RD STE 100
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374-3203
Country	:	US
Telephone Number	:	623-439-5176
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2025
Last Update Date	:	01/28/2026

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