Healthcare Provider Details

I. General information

NPI: 1841908969
Provider Name (Legal Business Name): MICHELLE LYNN MCCLOSKY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4306 ALTON RD FL 3
MIAMI BEACH FL
33140-2840
US

IV. Provider business mailing address

1498 JEFFERSON AVE APT 202
MIAMI BEACH FL
33139-3832
US

V. Phone/Fax

Practice location:
  • Phone: 305-535-3464
  • Fax:
Mailing address:
  • Phone: 248-933-5486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN11022580
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: