Healthcare Provider Details

I. General information

NPI: 1336161678
Provider Name (Legal Business Name): MICHELLE NICOLE DUANE DNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE NICOLE FOGEL

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

11999 SW AVENTINO DR
PORT ST LUCIE FL
34987-2310
US

V. Phone/Fax

Practice location:
  • Phone: 772-345-8100
  • Fax:
Mailing address:
  • Phone: 772-345-1144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9206273
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number9206273
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: