MEDICARE: MICHELLE PLAZA AGNP-C

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	363LA2200X	Adult Health Nurse Practitioner	APRN11028014	FL

General Provider Information

NPI Number	:	1346023892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE PLAZA AGNP-C

Provider Business Mailing Address
First Line	:	2833 W 71ST ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-5341
Country	:	US
Telephone Number	:	305-607-3178
Fax Number	:

Provider Business Practice Location Address
First Line	:	2833 W 71ST ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018
Country	:	US
Telephone Number	:	305-607-3178
Fax Number	:

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

Provider Enumeration Date	:	08/17/2023
Last Update Date	:	08/17/2023

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