Healthcare Provider Details

I. General information

NPI: 1164096871
Provider Name (Legal Business Name): MICHAEL ANTHONY TIGELEIRO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 SW INNOVATION WAY
PORT SAINT LUCIE FL
34987-2111
US

IV. Provider business mailing address

10850 SW PACINI WAY
PORT ST LUCIE FL
34987-6305
US

V. Phone/Fax

Practice location:
  • Phone: 772-345-8100
  • Fax:
Mailing address:
  • Phone: 561-766-3982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9114045
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: