Provider Demographics
NPI:1083064109
Name:MAZARD, MICHELA LAMBERT (APRN)
Entity type:Individual
Prefix:MRS
First Name:MICHELA
Middle Name:LAMBERT
Last Name:MAZARD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:MICHELA
Other - Middle Name:
Other - Last Name:LAMBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:60000 HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32512-0001
Mailing Address - Country:US
Mailing Address - Phone:850-505-6874
Mailing Address - Fax:850-505-6653
Practice Address - Street 1:60000 HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32512-0001
Practice Address - Country:US
Practice Address - Phone:850-505-6874
Practice Address - Fax:850-505-6653
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9327567363L00000X
FLARNP9327567363LF0000X
MN5286363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL363L00000XMedicaid