Provider Demographics
NPI:1548620883
Name:FLORES, MICHELLE ADRIANA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ADRIANA
Last Name:FLORES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 BACKSTAGE LANE
Mailing Address - Street 2:
Mailing Address - City:LAKE BUENA VISTA
Mailing Address - State:FL
Mailing Address - Zip Code:32830
Mailing Address - Country:US
Mailing Address - Phone:407-934-4100
Mailing Address - Fax:
Practice Address - Street 1:960 BACK STAGE LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32830-8472
Practice Address - Country:US
Practice Address - Phone:407-934-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9109287363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant