Provider Demographics
NPI:1770892770
Name:JOSEPH, MICHELLE V
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:V
Last Name:JOSEPH
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 1:281 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-7585
Mailing Address - Country:US
Mailing Address - Phone:386-283-3972
Mailing Address - Fax:
Practice Address - Street 1:281 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-7585
Practice Address - Country:US
Practice Address - Phone:386-283-3972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-25
Last Update Date:2010-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YP1600X
FL679987696372600000X, 373H00000X, 376J00000X
FL678996963747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No372600000XNursing Service Related ProvidersAdult Companion
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL679987696Medicaid