MEDICARE: HEATHER MARLISE CARMICHAEL ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SF0001X	Family Health Clinical Nurse Specialist	ARNP2967652	FL

General Provider Information

NPI Number	:	1770716425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER MARLISE CARMICHAEL ARNP

Provider Business Mailing Address
First Line	:	373 LAS PALMAS ST
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-1027
Country	:	US
Telephone Number	:	561-333-5022
Fax Number	:	561-333-0449

Provider Business Practice Location Address
First Line	:	12955 PALMS WEST DR STE 101
Second Line	:
City	:	LOXAHATCHEE
State	:	FL
Zip	:	33470-9212
Country	:	US
Telephone Number	:	561-333-5022
Fax Number	:	561-333-0449

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2009
Last Update Date	:	08/28/2009

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