Healthcare Provider Details

I. General information

NPI: 1861946733
Provider Name (Legal Business Name): JOSE ANTONIO COFINO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2016
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5961 NW 173RD DR
HIALEAH FL
33015-5114
US

IV. Provider business mailing address

1395 NW 167TH ST
MIAMI FL
33169-5710
US

V. Phone/Fax

Practice location:
  • Phone: 305-556-7500
  • Fax: 305-698-6521
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9289144
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: