Healthcare Provider Details

I. General information

NPI: 1104701366
Provider Name (Legal Business Name): MICKEY MIQUELI-PIAZZA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13535 SW 72ND AVE STE 170
PORTLAND OR
97223-8074
US

IV. Provider business mailing address

455 DEER CREEK LAKE POINT SOUTH LN
DEERFIELD BEACH FL
33442-8462
US

V. Phone/Fax

Practice location:
  • Phone: 971-300-0654
  • Fax:
Mailing address:
  • Phone: 561-906-9066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11040949
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11040949
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10050055
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: