MEDICARE: MR. MICHAEL DELANEUVILLE ARNP

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	9266339	FL
2	363LG0600X	Gerontology Nurse Practitioner	9266339	FL
3	363LP2300X	Primary Care Nurse Practitioner	9266339	FL

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

General Provider Information

NPI Number	:	1629488937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL DELANEUVILLE ARNP

Provider Business Mailing Address
First Line	:	1094 MILITARY TRL
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-7021
Country	:	US
Telephone Number	:	561-622-6111
Fax Number	:	855-215-9930

Provider Business Practice Location Address
First Line	:	1811 SW JAMESPORT DR
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-4599
Country	:	US
Telephone Number	:	561-312-3348
Fax Number	:

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

Provider Enumeration Date	:	05/08/2014
Last Update Date	:	08/21/2020

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