Provider Demographics
NPI:1154377182
Name:HILL, MICHELLE PEITZ (CRNA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:PEITZ
Last Name:HILL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:M
Other - Last Name:PEITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:19021 SE OUTRIGGER LN
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-1083
Mailing Address - Country:US
Mailing Address - Phone:561-743-3491
Mailing Address - Fax:
Practice Address - Street 1:3602 KYOTO GARDENS DR
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2713
Practice Address - Country:US
Practice Address - Phone:561-799-3388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9186893367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307165100Medicaid
FLG3819OtherBCBS OF FLORIDA
FLP00260924OtherRR MEDICARE
FLG3819YMedicare PIN