Basic Information
Provider Information
NPI: 1124335567
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PARKHILL
FirstName: MICHELE
MiddleName: NICOLE
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 151 SOUTHHALL LN
Address2: STE 300
City: MAITLAND
State: FL
PostalCode: 327517172
CountryCode: US
TelephoneNumber: 4078752080
FaxNumber: 4076503455
Practice Location
Address1: 1259 S CEDAR CREST BLVD
Address2: SUITE 100
City: ALLENTOWN
State: PA
PostalCode: 181036372
CountryCode: US
TelephoneNumber: 6104374134
FaxNumber: 6107700993
Other Information
ProviderEnumerationDate: 09/07/2010
LastUpdateDate: 09/13/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XMA055687PAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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