MEDICARE: GWENVANETTE CROMARTIE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	11-88-GH	FL
2	253Z00000X	In Home Supportive Care Agency	11-431-GH	FL
3	253Z00000X	In Home Supportive Care Agency	5113-5-GA	FL
4	253Z00000X	In Home Supportive Care Agency	11-88-GH	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265184956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWENVANETTE CROMARTIE

Provider Business Mailing Address
First Line	:	3730 NW 195TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-1938
Country	:	US
Telephone Number	:	305-621-6324
Fax Number	:	305-474-8566

Provider Business Practice Location Address
First Line	:	3730 NW 195TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-1938
Country	:	US
Telephone Number	:	305-621-6324
Fax Number	:	305-474-0969

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2022
Last Update Date	:	01/24/2022

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Directions to “ GWENVANETTE CROMARTIE ” Practice Location

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