Healthcare Provider Details

I. General information

NPI: 1659294551
Provider Name (Legal Business Name): MICHELLE SHERRY-ANN VANN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3107 N INDIAN RIVER DR
COCOA FL
32922-6607
US

IV. Provider business mailing address

PO BOX 237057
COCOA FL
32923-7057
US

V. Phone/Fax

Practice location:
  • Phone: 321-294-3716
  • Fax:
Mailing address:
  • Phone: 321-408-0138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number9429915
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: