Healthcare Provider Details

I. General information

NPI: 1851702674
Provider Name (Legal Business Name): JONATHAN PHILLIP NIEVES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W SAMPLE RD STE 204
DEERFIELD BEACH FL
33064-3547
US

IV. Provider business mailing address

1608 SE 3RD AVE FL 3
FORT LAUDERDALE FL
33316-2564
US

V. Phone/Fax

Practice location:
  • Phone: 954-785-0300
  • Fax: 954-785-0229
Mailing address:
  • Phone: 954-785-0300
  • Fax: 954-785-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberME135343
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: