Michelle J Van de Wall, APRN

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

APRN9165034 Issued in FL

Practice address

781 Cypress Village Blvd
Sun City Center, FL 33573-6801

Phone

(727) 824-0780

Fax

(727) 568-6011

NPI assigned

Dec 14, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Michelle James Former name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

University of South Florida College of Medicine, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Optumcare Florida, LLCGroup PAC ID 3072403476, 266 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Optumcare Florida LLC

  • General Practice Physician
  • Tampa, FL
  • NPI 1053384214
  Medicare reassignment Care Compare group NPD
• Optumcare Florida, LLC

  • Hospitalist Physician
  • Tampa, FL
  • NPI 1659884294
  NPD
• I.M.P.a.C.T, Medgroup, Inc

  • Internal Medicine Physician
  • Bradenton, FL
  • NPI 1427371921
  NPD (past)
• Optumcare Florida Ci, LLC

  • Primary Care Clinic/Center
  • Winter Park, FL
  • NPI 1720506603
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1292284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706054400000",
    "number": "1376846337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "781 CYPRESS VILLAGE BLVD",
            "city": "SUN CITY CENTER",
            "state": "FL",
            "postal_code": "335736801",
            "telephone_number": "727-824-0780",
            "fax_number": "727-568-6011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "781 CYPRESS VILLAGE BLVD",
            "city": "SUN CITY CENTER",
            "state": "FL",
            "postal_code": "335736801",
            "telephone_number": "727-824-0780",
            "fax_number": "727-568-6011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DE WALL",
        "first_name": "MICHELLE",
        "middle_name": "J",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-12-14",
        "last_updated": "2024-01-24",
        "certification_date": "2024-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "APRN9165034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "JAMES",
            "credential": "APRN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Tracey'S Health Care Service
• Tuong Tran, PHARM.D.
• Stefan Trimarco, PA0C
• Leah Tyler
• Ub of West FL, LLC.
• Joseph Daniel Vandenberg, OD
• Richard Michael Vanmatre, RPH
• Eduardo Manuel Vazquez, PA
• Isabel Vazquez, ATC
• Verimed Health Group Suncity, LLC

• Adult Health Nurse Practitioner in Sun City Center, FL
• Providers in Sun City Center, FL by specialty
• Adult Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.