Provider Demographics
NPI:1386242402
Name:VON DER HEYDE, MICHELLE ANDREA (APRN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANDREA
Last Name:VON DER HEYDE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14649 SW 42ND ST STE 500
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7825
Mailing Address - Country:US
Mailing Address - Phone:305-290-2175
Mailing Address - Fax:305-290-2176
Practice Address - Street 1:14649 SW 42ND ST STE 500
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-7825
Practice Address - Country:US
Practice Address - Phone:305-290-2175
Practice Address - Fax:305-291-2176
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11009875261QX0200X, 363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty