Healthcare Provider Details

I. General information

NPI: 1386242402
Provider Name (Legal Business Name): MICHELLE ANDREA VON DER HEYDE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3191 CORAL WAY STE 607
MIAMI FL
33145-3230
US

IV. Provider business mailing address

14649 SW 42ND ST STE 500
MIAMI FL
33175-7825
US

V. Phone/Fax

Practice location:
  • Phone: 305-290-2175
  • Fax: 305-291-2176
Mailing address:
  • Phone: 305-290-2175
  • Fax: 305-290-2176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11009875
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License NumberAPRN11009875
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11009875
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: