Provider Demographics
NPI:1578806485
Name:ST. LOUIS, MICAEL (ARNP)
Entity Type:Individual
Prefix:PROF
First Name:MICAEL
Middle Name:
Last Name:ST. LOUIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:MICAEL
Other - Middle Name:
Other - Last Name:CHARLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:3365 BURNS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4302
Mailing Address - Country:US
Mailing Address - Phone:561-799-5240
Mailing Address - Fax:561-493-8172
Practice Address - Street 1:3365 BURNS RD STE 100
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4302
Practice Address - Country:US
Practice Address - Phone:561-799-5240
Practice Address - Fax:561-493-8172
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9244052363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP 9244052OtherFLORIDA LICENSE
FLF0612558OtherAMERICAN ACADEMY OF NURSE PRACTIONERS