Provider Demographics
NPI:1902141260
Name:MULBERRY, MICHELL (DNP, ARNP-BC)
Entity Type:Individual
Prefix:
First Name:MICHELL
Middle Name:
Last Name:MULBERRY
Suffix:
Gender:F
Credentials:DNP, ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2318 NW 90TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6741
Mailing Address - Country:US
Mailing Address - Phone:856-718-7445
Mailing Address - Fax:
Practice Address - Street 1:2318 NW 90TH TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606
Practice Address - Country:US
Practice Address - Phone:856-718-7445
Practice Address - Fax:352-240-6321
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2018-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9431696363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty