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NPI Code Detail

MEDICARE: MICHELLE DORMAN PA

MEDICARE: MICHELLE DORMAN PA
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 Assistant9112742FL

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 : 1588207120
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE DORMAN PA
Provider Business Mailing Address
First Line : 1617 SE NORTH BLACKWELL DR
Second Line :
City : PORT ST LUCIE
State : FL
Zip : 34952-6651
Country : US
Telephone Number : 901-626-1389
Fax Number :
Provider Business Practice Location Address
First Line : 2601 S KANNER HWY
Second Line :
City : STUART
State : FL
Zip : 34994-4622
Country : US
Telephone Number : 901-626-1389
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2019
Last Update Date : 07/28/2025

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Directions to “ MICHELLE DORMAN PA” Practice Location

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