Healthcare Provider Details

I. General information

NPI: 1205545720
Provider Name (Legal Business Name): MRS. MICHELLE SCHMIDT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 NW 12TH AVE FL 1
MIAMI FL
33136-1005
US

IV. Provider business mailing address

3135 GIFFORD LN APT A
MIAMI FL
33133-4448
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-3166
  • Fax:
Mailing address:
  • Phone: 954-593-7036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11023147
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: