Healthcare Provider Details

I. General information

NPI: 1992245450
Provider Name (Legal Business Name): MICHELLE NUNES CARAVAGLIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2017
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 13TH AVE S STE 215
JACKSONVILLE BEACH FL
32250-3206
US

IV. Provider business mailing address

PO BOX 746649
ATLANTA GA
30374-6649
US

V. Phone/Fax

Practice location:
  • Phone: 904-249-1041
  • Fax: 904-249-9764
Mailing address:
  • Phone: 904-376-4400
  • Fax: 904-391-5595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME150670
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License NumberME150670
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: