Provider Demographics
NPI:1043037138
Name:PEARSON, MICHELE RENEE (APRN-PMH, BC)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:RENEE
Last Name:PEARSON
Suffix:
Gender:F
Credentials:APRN-PMH, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5649 SANDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8500
Mailing Address - Country:US
Mailing Address - Phone:601-479-9089
Mailing Address - Fax:
Practice Address - Street 1:1115 E GONZALEZ ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-6050
Practice Address - Country:US
Practice Address - Phone:239-690-6906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-20
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11035456363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health