Provider Demographics
NPI:1265415103
Name:MADAN, MICHELLE JANE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:JANE
Last Name:MADAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:269 PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-2555
Mailing Address - Country:US
Mailing Address - Phone:321-383-9529
Mailing Address - Fax:321-383-9529
Practice Address - Street 1:401 N WICKHAM RD
Practice Address - Street 2:SUITE S
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8659
Practice Address - Country:US
Practice Address - Phone:321-242-9031
Practice Address - Fax:321-242-9035
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9216767363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner