MEDICARE: MICHELE E PEDULLA ARNP

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	363LP0200X	Pediatric Nurse Practitioner	ARNP1658012	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1295057719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE E PEDULLA ARNP

Provider Business Mailing Address
First Line	:	1802 CLEARBROOKE DR
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33760-1429
Country	:	US
Telephone Number	:	727-849-2535
Fax Number	:	727-849-7157

Provider Business Practice Location Address
First Line	:	5411 GRAND BLVD
Second Line	:	SUITE 102
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4010
Country	:	US
Telephone Number	:	727-849-2535
Fax Number	:	727-849-7157

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

Provider Enumeration Date	:	02/25/2010
Last Update Date	:	03/13/2020

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Directions to “ MICHELE E PEDULLA ARNP” Practice Location

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