Healthcare Provider Details

I. General information

NPI: 1508120973
Provider Name (Legal Business Name): JLM NURSE PRACTITIONERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 06/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 W 68TH ST SUITE 305
HIALEAH FL
33016-1815
US

IV. Provider business mailing address

2140 W 68TH ST SUITE 300
HIALEAH FL
33016-1815
US

V. Phone/Fax

Practice location:
  • Phone: 305-822-4107
  • Fax: 786-497-2989
Mailing address:
  • Phone: 305-822-4107
  • Fax: 786-497-2989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME0065252
License Number StateFL

VIII. Authorized Official

Name: MR. JOSE LUIS MARTINEZ
Title or Position: MANAGER
Credential: M.D.
Phone: 305-822-4107