Healthcare Provider Details

I. General information

NPI: 1629934070
Provider Name (Legal Business Name): MICHELLE KOVAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1967 S OCEAN BLVD APT 318
POMPANO BEACH FL
33062-8040
US

IV. Provider business mailing address

1967 S OCEAN BLVD APT 318
POMPANO BEACH FL
33062-8040
US

V. Phone/Fax

Practice location:
  • Phone: 646-460-2339
  • Fax:
Mailing address:
  • Phone: 646-460-2339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15538200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11045082
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: