Provider Demographics
NPI:1659252518
Name:CANTRELL, MICHELLE CRISOSTOMO (RN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CRISOSTOMO
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 DISCOVERY LOOP N
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-2955
Mailing Address - Country:US
Mailing Address - Phone:904-910-1260
Mailing Address - Fax:
Practice Address - Street 1:1621 TENNESSEE AVE STE 300
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-3604
Practice Address - Country:US
Practice Address - Phone:850-872-0774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-09
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11042311363L00000X
FLRN9654754163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse