Provider Demographics
NPI:1093741845
Name:MUSKUS, MICHELE ROMAN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:ROMAN
Last Name:MUSKUS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:ESTHER
Other - Last Name:ROMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPARTMENT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:407-650-7117
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:100 E SYBELIA AVE STE 100
Practice Address - Street 2:NEMOURS CHILDRENS PRIMARY CARE
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4748
Practice Address - Country:US
Practice Address - Phone:407-636-6520
Practice Address - Fax:407-636-6525
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1713562363LP0200X
FLARNP1713562363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000807900Medicaid