Michelle Lea Antanovich, CRNP PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

SP022065 Issued in PA

Practice address

1485 Wassail LN
Punta Gorda, FL 33983-6028

Phone

(941) 286-5033

NPI assigned

Sep 1, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jul 1, 2026 through Jul 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sohomd.michelleantanovich@157389.advancedmd-direct.com
• Direct secure messaging: hr.credentialing@sohomd.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Inspired Life Behavioral Health & Counseling, NP, LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Punta Gorda, FL
  • NPI 1720835101
  NPD Authorized official
• Lukas Behavioral Health LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Cumberland, MD
  • NPI 1326702788

  Psychiatric/Mental Health

  NPD
• Neuropsychiatric Services, PC

  • Psychiatry Physician
  • New York, NY
  • NPI 1508451121
  NPD
• Soho Medical Doctors, PLLC

  • Psychiatry Physician
  • New York, NY
  • NPI 1497184568
  NPD
• Mon-Vale Primary Care, Inc.

  • Nurse Practitioner
  • Finleyville, PA
  • NPI 1013201466
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710115200000",
    "number": "1487756458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1485 WASSAIL LN",
            "city": "PUNTA GORDA",
            "state": "FL",
            "postal_code": "339836028",
            "telephone_number": "941-286-5033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1485 WASSAIL LN",
            "city": "PUNTA GORDA",
            "state": "FL",
            "postal_code": "339836028",
            "telephone_number": "941-286-5033"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "104 W 40th St Rm 500",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100183770",
            "country_code": "US",
            "telephone_number": "212-369-6757",
            "fax_number": "212-369-3941",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANTANOVICH",
        "first_name": "MICHELLE",
        "middle_name": "LEA",
        "credential": "CRNP PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-01",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "PA",
            "license": "SP022065",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP006096B",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "HR.credentialing@sohomd.com",
            "affiliation": "N",
            "endpointDescription": "emial address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "emial",
            "address_1": "104 W 40th St Rm 500",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100183770",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• American Home Therapy Provider, Inc.
• Anemone Emergency Physicians, LLC
• Angela Keon MD LLC
• Fabiola Anglade-Pascal, ARNP
• Annette C Romero, PLLC
• Rae Ann Antonucci, P.A.
• Shawn Escar Arkon, APRN
• Whitney Armenio, MS, CCC-SLP
• Estuardo E. Aroca, D.O
• Robert J Aruta, DC, DABCO

• Psychiatric/Mental Health Nurse Practitioner in Punta Gorda, FL
• Providers in Punta Gorda, FL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.