Provider Demographics
NPI:1144082900
Name:MICHIELSSEN, MADISON PAIGE (FNTP, CN, CPT)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:PAIGE
Last Name:MICHIELSSEN
Suffix:
Gender:F
Credentials:FNTP, CN, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2019
Mailing Address - Country:US
Mailing Address - Phone:407-284-5191
Mailing Address - Fax:
Practice Address - Street 1:1625 SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2019
Practice Address - Country:US
Practice Address - Phone:407-284-5191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach