Provider Demographics
NPI:1487293296
Name:BOAS, MICHAEL (PMHNP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BOAS
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14201 W SUNRISE BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-3207
Mailing Address - Country:US
Mailing Address - Phone:954-754-5407
Mailing Address - Fax:954-851-9688
Practice Address - Street 1:14201 W SUNRISE BLVD STE 208
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-3207
Practice Address - Country:US
Practice Address - Phone:954-754-5407
Practice Address - Fax:954-851-9688
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-26
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11005769363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health