Provider Demographics
NPI:1306507058
Name:TREVINO, MICHELLE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:TREVINO
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12509 STONE TOWER LOOP
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-6781
Mailing Address - Country:US
Mailing Address - Phone:651-336-6468
Mailing Address - Fax:651-666-1619
Practice Address - Street 1:228 PLAZA DR STE D
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-6054
Practice Address - Country:US
Practice Address - Phone:239-236-8784
Practice Address - Fax:651-666-1619
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11017274363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health