NPIMap

Individual provider Active NPI

Michele Lynn Eckbold, NP

  • Gerontology Nurse Practitioner
  • Melbourne, FL
National Provider Identifier
1689434805
Registry record updated Mar 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
11031951 Issued in FL
Practice address
1900 S Harbor City Blvd Ste 230
Melbourne, FL 32901-4789
Phone
(321) 216-2288
NPI assigned
Mar 22, 2024
Last updated
Mar 26, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 11031951 FL Primary

Addresses

Primary practice location

1900 S Harbor City Blvd Ste 230
Melbourne, FL 32901-4789

Mailing address

812 Banks St NW
Palm Bay, FL 32907-8263
Phone (610) 563-0534

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240620000233 FL Practitioner - Nurse Practitioner 3375086259 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Healthcare Services IncGroup PAC ID 2163339722, shared by 46 NPIs, 3,431 clinicians
A Kut Above Mobile Medical IncGroup PAC ID 3779921929, 4 clinicians
Practitioners in Motion PLLCGroup PAC ID 9335456755, 9 clinicians

Practice addresses (Care Compare)

17470 Brookside Trace CT
Tampa, FL 33647-6201
Phone (813) 443-5042

1785 Waverly PL
Suite a
Melbourne, FL 32901-4641
Phone (321) 216-2288

1900 S Harbor Blvd
Suite 232
Melbourne, FL 32901-3805
Phone (321) 216-2288

2855 Murrell Rd
Rockledge, FL 32955-4269
Phone (321) 208-8778

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11031951FLMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
A Kut Above Mobile Medical Inc CurrentSince Mar 22, 2024 Accepting new patients
Practitioners in Motion PLLC CurrentSince Mar 22, 2024 Accepting new patients

Locations

1785 Waverly Pl
Ste A
Melbourne, FL 32901
Phone (321) 216-2288

1900 S Harbor City Blvd
Ste 232
Melbourne, FL 32901
Phone (321) 216-2288

Organizations & group practices 2

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

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1711065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711411200000",
    "number": "1689434805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "812 BANKS ST NW",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329078263",
            "telephone_number": "610-563-0534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 S HARBOR CITY BLVD STE 230",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329014789",
            "telephone_number": "321-216-2288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ECKBOLD",
        "first_name": "MICHELE",
        "middle_name": "LYNN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-22",
        "last_updated": "2024-03-26",
        "certification_date": "2024-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "FL",
            "license": "11031951",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

Verify at the official NPI Registry.