MEDICARE: MRS. MICHELLE FORMOSO ARNP-C

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	363LF0000X	Family Nurse Practitioner	ARNP9264772	FL

General Provider Information

NPI Number	:	1992082804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE FORMOSO ARNP-C

Provider Business Mailing Address
First Line	:	14048 SW 83RD PL
Second Line	:
City	:	PALMETTO BAY
State	:	FL
Zip	:	33158-1400
Country	:	US
Telephone Number	:	305-467-7657
Fax Number	:

Provider Business Practice Location Address
First Line	:	6498 SW 24TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-1949
Country	:	US
Telephone Number	:	305-964-7392
Fax Number	:

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

Provider Enumeration Date	:	11/05/2011
Last Update Date	:	11/09/2011

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