Provider Demographics
NPI:1417126418
Name:OWEN, MICHAEL V (APRN)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:V
Last Name:OWEN
Suffix:
Gender:M
Credentials:APRN
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Mailing Address - Street 1:4881 NW 8TH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4582
Mailing Address - Country:US
Mailing Address - Phone:352-416-1082
Mailing Address - Fax:352-376-0455
Practice Address - Street 1:4343 W NEWBERRY RD
Practice Address - Street 2:SUITE 10
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2825
Practice Address - Country:US
Practice Address - Phone:352-376-2608
Practice Address - Fax:352-376-0455
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2024-05-30
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Provider Licenses
StateLicense IDTaxonomies
FLARNP2059552363LF0000X, 163WR0006X
FLAPRN2059552363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDA273ZMedicare PIN