Cristine Palacios Miclat, APRN, BC

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

RN135637 Issued in GA

Practice address

1061 Harmon Ave
Ste 1D03
Fort Stewart, GA 31314-5641

Phone

(912) 435-6965

NPI assigned

Feb 3, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in GA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• MPPG, Inc.

  • Family Medicine Physician
  • Savannah, GA
  • NPI 1033131172
  Medicare reassignment NPD

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

{
    "created_epoch": "1233619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482796800000",
    "number": "1649418310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1061 HARMON AVE",
            "address_2": "STE 1D03",
            "city": "FORT STEWART",
            "state": "GA",
            "postal_code": "313145641",
            "telephone_number": "912-435-6965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1061 HARMON AVE",
            "address_2": "STE 1D03",
            "city": "FORT STEWART",
            "state": "GA",
            "postal_code": "313145641",
            "telephone_number": "912-435-6965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICLAT",
        "first_name": "CRISTINE",
        "middle_name": "PALACIOS",
        "credential": "APRN, BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-02-03",
        "last_updated": "2016-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "GA",
            "license": "RN135637",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "01299571",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "158532534B",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00714517",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jester Isaiah Cruz Mendoza, PA
• Dalia Rebecca Merced, MD
• Samantha M Mezcua-Tettey, LMFT
• Olivia Ngozi Mgbeokwere, MS, FNP-C
• Cynthia Michael
• Brandy L Middleton, RN
• Charles Edward Middleton III, DDS
• Nia Robinson Middleton, M.D.
• Katherine Erika Milbury, DO
• Connie Miles

• Adult Health Nurse Practitioner in Fort Stewart, GA
• Providers in Fort Stewart, GA by specialty
• Adult Health Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.