MEDICARE: FLORIDA ATLANTIC UNIVERSITY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
2	207Q00000X	Family Medicine Physician
3	364SS0200X	School Clinical Nurse Specialist
4	363L00000X	Nurse Practitioner
5	261QF0400X	Federally Qualified Health Center (FQHC)

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	K3331C	OTHER	FL	FQHC-MEDICARE
3	C111027	OTHER	FL	FQHC-MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	002Z8	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1376856658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA ATLANTIC UNIVERSITY

Provider Business Mailing Address
First Line	:	720 8TH ST
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-3606
Country	:	US
Telephone Number	:	561-803-8880
Fax Number	:	877-409-1795

Provider Business Practice Location Address
First Line	:	720 8TH ST
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-3606
Country	:	US
Telephone Number	:	561-803-8880
Fax Number	:	877-409-1795

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	LOUISA PONTIROLI KELLY
Credential	:
Telephone Number	:	561-803-8880

Provider Enumeration Date	:	07/15/2010
Last Update Date	:	12/15/2025

Similar Medicare Providers

1497832083 — DR. LYSA CHARLES MD
Practice Location Address:

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST , KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-6660
Practice Fax: 301-816-6308

1497801583 — TOWN OF PALM BEACH
Practice Location Address:

300 N COUNTY RD
PALM BEACH, FL
33480-3606

Practice Phone: 561-838-5420
Practice Fax: 561-838-5408

1972587079 — TRACY LYNN CHUCK MSPT
Practice Location Address:

73600 ALESSANDRO DR
PALM DESERT, CA
92260-3606

Practice Phone: 760-674-0675
Practice Fax: 760-674-0645

1144244922 — JASON M STODELLE MPT
Practice Location Address:

73600 ALESSANDRO DR
PALM DESERT, CA
92260-3606

Practice Phone: 760-674-0675
Practice Fax: 760-674-0645

1902467343 — MARIA VERONICA ALVAREZ
Practice Location Address:

6155 PALM AVE APT 3606
SAN BERNARDINO, CA
92407-2095

Practice Phone: 909-252-9478
Practice Fax:

1720609969 — MEGHAN ELIZABETH GUARINO DNP
Practice Location Address:

2907 BOXWOOD CT
PALM HARBOR, FL
34684-3606

Practice Phone: 727-692-5823
Practice Fax:

Directions to “FLORIDA ATLANTIC UNIVERSITY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.