Provider Demographics
NPI:1386373082
Name:RUSHING, MICHAEL K (FNP-BC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:K
Last Name:RUSHING
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4565 CARMEL CIR
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-1164
Mailing Address - Country:US
Mailing Address - Phone:850-572-4901
Mailing Address - Fax:
Practice Address - Street 1:5565 WOODBINE RD
Practice Address - Street 2:STE 3
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571
Practice Address - Country:US
Practice Address - Phone:850-290-5615
Practice Address - Fax:850-290-5615
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAA-NP001381363LF0000X
COC-APN.0100823-C-NP363LF0000X
FLAPRN11020222363LF0000X
AL1-115204363LF0000X
TX1116322363LF0000X
TN31802363LF0000X
WV115830363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty