Healthcare Provider Details

I. General information

NPI: 1942016647
Provider Name (Legal Business Name): MIMOSE GELIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S FEDERAL HWY
FORT LAUDERDALE FL
33316-2619
US

IV. Provider business mailing address

1401 S FEDERAL HWY
FORT LAUDERDALE FL
33316-2619
US

V. Phone/Fax

Practice location:
  • Phone: 954-728-1083
  • Fax: 954-779-2316
Mailing address:
  • Phone: 954-728-1083
  • Fax: 954-779-2316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: