MEDICARE: COLLEEN MICHELLE CLASS 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
1	363A00000X	Physician Assistant	PA9120522	FL

General Provider Information

NPI Number	:	1730959339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN MICHELLE CLASS PA

Provider Business Mailing Address
First Line	:	PO BOX 95590
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-0590
Country	:	US
Telephone Number	:	801-784-0954
Fax Number	:	801-352-7976

Provider Business Practice Location Address
First Line	:	125 BAPTIST WAY STE 4A
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32503-2274
Country	:	US
Telephone Number	:	448-227-6360
Fax Number	:	850-469-7849

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

Provider Enumeration Date	:	01/04/2024
Last Update Date	:	05/05/2026

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Directions to “ COLLEEN MICHELLE CLASS PA” Practice Location

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