MEDICARE: MISS MICHELLE BROOKE MOWRY NP

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	9186846	FL

General Provider Information

NPI Number	:	1770563918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MICHELLE BROOKE MOWRY NP

Provider Business Mailing Address
First Line	:	17717 BRIDLE LN
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33478-4717
Country	:	US
Telephone Number	:	561-512-6887
Fax Number	:

Provider Business Practice Location Address
First Line	:	5540 PGA BLVD
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3987
Country	:	US
Telephone Number	:	561-630-8929
Fax Number	:

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

Provider Enumeration Date	:	01/21/2006
Last Update Date	:	07/08/2007

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