Provider Demographics
NPI:1285691568
Name:PITTARD, MICHELLE H (RN, MSN, ANPC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:H
Last Name:PITTARD
Suffix:
Gender:F
Credentials:RN, MSN, ANPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E CHEVES ST STE 260
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2652
Mailing Address - Country:US
Mailing Address - Phone:843-665-7941
Mailing Address - Fax:843-665-1257
Practice Address - Street 1:800 E CHEVES ST STE 260
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2652
Practice Address - Country:US
Practice Address - Phone:843-665-7941
Practice Address - Fax:843-665-1257
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN 2177363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0887Medicaid
Q42713Medicare UPIN
SCNP0887Medicaid