Provider Demographics
NPI:1104674753
Name:SIN, MICHELLE NICHOLE (ACNPC-AG)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:NICHOLE
Last Name:SIN
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3679 COCOPLUM CIR UNIT 3528
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5934
Mailing Address - Country:US
Mailing Address - Phone:717-658-8353
Mailing Address - Fax:
Practice Address - Street 1:3679 COCOPLUM CIR UNIT 3528
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33063-5934
Practice Address - Country:US
Practice Address - Phone:717-658-8353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11032743363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care