Healthcare Provider Details

I. General information

NPI: 1336718196
Provider Name (Legal Business Name): HILDA LOUISE HARVEY CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W CYPRESS CREEK RD STE 400H
FORT LAUDERDALE FL
33309-1951
US

IV. Provider business mailing address

1001 W CYPRESS CREEK RD STE 400H
FORT LAUDERDALE FL
33309-1951
US

V. Phone/Fax

Practice location:
  • Phone: 954-765-6534
  • Fax: 954-477-8376
Mailing address:
  • Phone: 954-765-6534
  • Fax: 954-477-8376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number30211514
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: