MEDICARE: MIKAELA NICOLE PAICELY APRN

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	11036473	FL

General Provider Information

NPI Number	:	1689498081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKAELA NICOLE PAICELY APRN

Provider Business Mailing Address
First Line	:	18914 SW 93RD CT
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33157-7954
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9380 SW 150TH ST STE 210
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-7979
Country	:	US
Telephone Number	:	305-585-8746
Fax Number	:

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

Provider Enumeration Date	:	11/12/2024
Last Update Date	:	04/17/2025

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