Individual provider Active NPI

Michelle Johnson, APRN-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Clearwater, FL
National Provider Identifier
1588067284
Registry record updated Feb 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
APRN9387047 Issued in FL
Practice address
1938 Soule Rd
Clearwater, FL 33759-1507
Phone
(727) 726-7442
Fax
(727) 288-1111
NPI assigned
Oct 8, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 17, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X APRN9387047 FL Primary

Addresses

Primary practice location

1938 Soule Rd
Clearwater, FL 33759-1507

Mailing address

1938 Soule Rd
Clearwater, FL 33759-1507
Phone (727) 726-7442

Other names 1

  • Michelle Wanta Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211117001680 FL Practitioner - Nurse Practitioner 2365831179

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1938 Soule Rd
Clearwater, FL 33759-1507

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN9387047FLMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
A&M Psychiatric Services PA CurrentSince Oct 8, 2021 Accepting new patients

Locations

1938 Soule Rd
Clearwater, FL 33759
Phone (727) 726-7442

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1412726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645056000000",
    "number": "1588067284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1938 SOULE RD",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337591507",
            "telephone_number": "727-726-7442",
            "fax_number": "727-288-1111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1938 SOULE RD",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337591507",
            "telephone_number": "727-726-7442",
            "fax_number": "727-288-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MICHELLE",
        "credential": "APRN-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-08",
        "last_updated": "2022-02-17",
        "certification_date": "2022-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "APRN9387047",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "WANTA",
            "credential": "PNP-BC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Clearwater, FL

Sources for this page

Verify at the official NPI Registry.