Provider Demographics
NPI:1063688257
Name:JAFFE, MICHELLE KAREN (ARNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KAREN
Last Name:JAFFE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5395 FIRENZE DR
Mailing Address - Street 2:SUITE#M
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-2125
Mailing Address - Country:US
Mailing Address - Phone:561-376-4608
Mailing Address - Fax:561-362-0588
Practice Address - Street 1:5395 FIRENZE DR
Practice Address - Street 2:SUITE#M
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-2125
Practice Address - Country:US
Practice Address - Phone:561-376-4608
Practice Address - Fax:561-362-0588
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3093532363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS74750Medicare UPIN