Healthcare Provider Details

I. General information

NPI: 1740576453
Provider Name (Legal Business Name): MICHELLE MISIK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 INDIAN RIVER BLVD
VERO BEACH FL
32960-5225
US

IV. Provider business mailing address

2750 INDIAN RIVER BLVD
VERO BEACH FL
32960-5225
US

V. Phone/Fax

Practice location:
  • Phone: 772-569-9500
  • Fax:
Mailing address:
  • Phone: 772-569-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP2180992
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: