Basic Information
| Provider Information | |||||||||
| NPI: | 1568931335 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MICHAELIS | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | FLETCHER | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7653 WINGED FOOT DR | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339675021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2394709269 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13020 LIVINGSTON RD STE 14 | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341055023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2392633330 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2018 | ||||||||
| LastUpdateDate: | 11/21/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 9111502 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.