Healthcare Provider Details

I. General information

NPI: 1114625712
Provider Name (Legal Business Name): MICHAEL RONSELLI APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 07/09/2023
Certification Date: 07/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14150 SW 136TH ST
MIAMI FL
33186-5506
US

IV. Provider business mailing address

11400 SW 107TH AVE
MIAMI FL
33176-4025
US

V. Phone/Fax

Practice location:
  • Phone: 786-204-4600
  • Fax:
Mailing address:
  • Phone: 786-218-9409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11026517
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: