Healthcare Provider Details

I. General information

NPI: 1902494354
Provider Name (Legal Business Name): MICHAELLE VALCOURT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2020
Last Update Date: 06/18/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18117 BISCAYNE BLVD STE 2496
AVENTURA FL
33160-2535
US

IV. Provider business mailing address

18117 BISCAYNE BLVD STE 2496
AVENTURA FL
33160-2535
US

V. Phone/Fax

Practice location:
  • Phone: 305-457-5707
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11040275
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9495238
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: