Basic Information
| Provider Information | |||||||||
| NPI: | 1841760832 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COWARD | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | LUCILLE | ||||||||
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| Credential: | APRN FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3372 SHERWOOD RD | ||||||||
| Address2: | |||||||||
| City: | PORT CHARLOTTE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339808769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9419790370 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 19531 COCHRAN BLVD | ||||||||
| Address2: | |||||||||
| City: | PORT CHARLOTTE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339482081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417877111 | ||||||||
| FaxNumber: | 9417667999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2018 | ||||||||
| LastUpdateDate: | 09/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 11000337 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.