Healthcare Provider Details

I. General information

NPI: 1083578041
Provider Name (Legal Business Name): MICHAELA VANDAL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 NE 159TH ST
NORTH MIAMI BEACH FL
33162-4739
US

IV. Provider business mailing address

1665 NE 159TH ST
NORTH MIAMI BEACH FL
33162-4739
US

V. Phone/Fax

Practice location:
  • Phone: 786-262-4264
  • Fax:
Mailing address:
  • Phone: 786-262-4264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11041961
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: