Provider Demographics
NPI:1740705607
Name:FEFFER, MICHELLE KAREN (ANRP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KAREN
Last Name:FEFFER
Suffix:
Gender:F
Credentials:ANRP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:KAREN
Other - Last Name:FEFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 NW 10TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1344
Mailing Address - Country:US
Mailing Address - Phone:561-391-2708
Mailing Address - Fax:
Practice Address - Street 1:1500 NW 10TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1344
Practice Address - Country:US
Practice Address - Phone:561-391-2708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2020-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9344802363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2017009031OtherANCC CERTIFICATION