Provider Demographics
NPI:1508577495
Name:PROPHYL, MICHEL ANGE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MICHEL ANGE
Middle Name:
Last Name:PROPHYL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7929 AZTEC CT
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-8038
Mailing Address - Country:US
Mailing Address - Phone:954-851-5140
Mailing Address - Fax:
Practice Address - Street 1:7929 AZTEC CT
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-8038
Practice Address - Country:US
Practice Address - Phone:954-851-5140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11015800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily