Provider Demographics
NPI:1144517814
Name:OVERTURF, MICHELLE ANNE (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANNE
Last Name:OVERTURF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 10TH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1407
Mailing Address - Country:US
Mailing Address - Phone:727-824-7134
Mailing Address - Fax:727-824-8329
Practice Address - Street 1:4902 EISENHOWER BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-6310
Practice Address - Country:US
Practice Address - Phone:813-636-2047
Practice Address - Fax:813-321-6998
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL33874207R00000X
FLME124489207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine