Provider Demographics
NPI:1356778427
Name:VALLEJO, MICHELLE (ARNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:VALLEJO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14651 PALM BEACH BLVD, STE. 100
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905
Mailing Address - Country:US
Mailing Address - Phone:238-369-2903
Mailing Address - Fax:239-369-0500
Practice Address - Street 1:14651 PALM BEACH BLVD, STE. 100
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905
Practice Address - Country:US
Practice Address - Phone:238-369-2903
Practice Address - Fax:239-369-0500
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2024-08-17
Deactivation Date:2024-08-12
Deactivation Code:
Reactivation Date:2024-08-16
Provider Licenses
StateLicense IDTaxonomies
FLRN9335152163W00000X
FLAPRN11034570363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse