Healthcare Provider Details

I. General information

NPI: 1720629272
Provider Name (Legal Business Name): MICHELLE KIRSHBAUM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 S SEACREST BLVD
BOYNTON BEACH FL
33435-7969
US

IV. Provider business mailing address

5700 LAKE WORTH RD STE 204
GREENACRES FL
33463-3213
US

V. Phone/Fax

Practice location:
  • Phone: 561-737-7733
  • Fax:
Mailing address:
  • Phone: 561-966-7717
  • Fax: 888-316-2198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF08190143
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: