Healthcare Provider Details

I. General information

NPI: 1073132908
Provider Name (Legal Business Name): JENNIFER LYDIA HORAWSKI MD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date: 01/10/2022
Reactivation Date: 01/25/2022

III. Provider practice location address

5555 PONCE DE LEON BLVD
CORAL GABLES FL
33146-2513
US

IV. Provider business mailing address

5555 PONCE DE LEON BLVD
CORAL GABLES FL
33146-2513
US

V. Phone/Fax

Practice location:
  • Phone: 843-848-4640
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME166840
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: