MEDICARE: MICHELLE AMENGUAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	9267070	FL

General Provider Information

NPI Number	:	1093311524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE AMENGUAL

Provider Business Mailing Address
First Line	:	2406 N FEDERAL HWY
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33305-2541
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2406 N FEDERAL HWY
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33305-2541
Country	:	US
Telephone Number	:	954-860-8687
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2020
Last Update Date	:	12/09/2020

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Directions to “ MICHELLE AMENGUAL ” Practice Location

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