Provider Demographics
NPI:1124701487
Name:HAND, MICHELLE LEE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:HAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LEE
Other - Last Name:BARRENECHEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12862B CHURCHILL DR
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-8741
Mailing Address - Country:US
Mailing Address - Phone:954-616-9695
Mailing Address - Fax:
Practice Address - Street 1:1114 SHELTON BEACH RD
Practice Address - Street 2:
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571-3016
Practice Address - Country:US
Practice Address - Phone:251-633-0123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9119151363A00000X
390200000X
ALPA.2525363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program