Provider Demographics
NPI:1912302431
Name:HERRINGSHAW, MICHAEL (MSN, FNP-C, RN, RCIS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HERRINGSHAW
Suffix:
Gender:M
Credentials:MSN, FNP-C, RN, RCIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11616 LAKE UNDERHILL RD
Mailing Address - Street 2:STE 215
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-4463
Mailing Address - Country:US
Mailing Address - Phone:407-482-7788
Mailing Address - Fax:407-482-8698
Practice Address - Street 1:11616 LAKE UNDERHILL RD
Practice Address - Street 2:STE 215
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825
Practice Address - Country:US
Practice Address - Phone:407-482-7788
Practice Address - Fax:407-482-8698
Is Sole Proprietor?:No
Enumeration Date:2014-10-27
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9304278363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily