Healthcare Provider Details

I. General information

NPI: 1013385053
Provider Name (Legal Business Name): MISELINE LAGESSE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISELINE FABRE FNP

II. Dates (important events)

Enumeration Date: 09/08/2015
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S 23RD ST
FORT PIERCE FL
34950-4803
US

IV. Provider business mailing address

10110 W VERONA CIR
VERO BEACH FL
32966-3129
US

V. Phone/Fax

Practice location:
  • Phone: 305-318-1388
  • Fax:
Mailing address:
  • Phone: 305-318-1388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9245364
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number9245364
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: