Healthcare Provider Details

I. General information

NPI: 1992091631
Provider Name (Legal Business Name): MICHAEL PAUL LEVAUGH ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4944 HIGHWAY 90
PACE FL
32571-1413
US

IV. Provider business mailing address

4944 HIGHWAY 90
PACE FL
32571-1413
US

V. Phone/Fax

Practice location:
  • Phone: 850-994-0431
  • Fax: 850-994-0904
Mailing address:
  • Phone: 850-994-0431
  • Fax: 850-994-0904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9232865
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: