Healthcare Provider Details

I. General information

NPI: 1669945747
Provider Name (Legal Business Name): MICHELIE LEVRIER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELIE ROSARIO

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2013 LIVE OAK BLVD STE C
SAINT CLOUD FL
34771-8410
US

IV. Provider business mailing address

2013 LIVE OAK BLVD STE C
SAINT CLOUD FL
34771-8410
US

V. Phone/Fax

Practice location:
  • Phone: 407-593-2388
  • Fax: 407-593-2392
Mailing address:
  • Phone: 407-593-2388
  • Fax: 407-593-2392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11000869
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11000869
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: