Provider Demographics
NPI:1205250065
Name:SCHAROUN, MICHELINE
Entity type:Individual
Prefix:
First Name:MICHELINE
Middle Name:
Last Name:SCHAROUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2063 62ND TER S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-5729
Mailing Address - Country:US
Mailing Address - Phone:727-433-2634
Mailing Address - Fax:727-289-3001
Practice Address - Street 1:2063 62ND TER S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-5729
Practice Address - Country:US
Practice Address - Phone:727-433-2634
Practice Address - Fax:727-289-3001
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL692273298Medicaid