Provider Demographics
NPI:1659835437
Name:FLEURIOT, MIRLANGE ODIES (NP)
Entity Type:Individual
Prefix:
First Name:MIRLANGE
Middle Name:ODIES
Last Name:FLEURIOT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2242 SW NEWPORT ISLES BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-4577
Mailing Address - Country:US
Mailing Address - Phone:772-626-7315
Mailing Address - Fax:
Practice Address - Street 1:2242 SW NEWPORT ISLES BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-4577
Practice Address - Country:US
Practice Address - Phone:772-626-7315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF11180693363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner