MEDICARE: MICHELLE MARIE LENAHAN PA-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	363A00000X	Physician Assistant	PA9119427	FL
2	363AM0700X	Medical Physician Assistant	PA9119427	FL
3	363AS0400X	Surgical Physician Assistant	PA9119427	FL

General Provider Information

NPI Number	:	1518799303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE MARIE LENAHAN PA-C

Provider Business Mailing Address
First Line	:	705 WELLS RD STE 300
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-2982
Country	:	US
Telephone Number	:	904-621-0671
Fax Number	:

Provider Business Practice Location Address
First Line	:	8262 POINT MEADOWS DR STE 202
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-4702
Country	:	US
Telephone Number	:	904-265-4310
Fax Number	:	904-265-4311

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

Provider Enumeration Date	:	08/19/2024
Last Update Date	:	11/04/2024

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