Healthcare Provider Details

I. General information

NPI: 1780227074
Provider Name (Legal Business Name): DANIELLA DENYSE KHEMNARINE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2019
Last Update Date: 08/30/2023
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 S OCEAN DR STE 209
HOLLYWOOD FL
33019-2915
US

IV. Provider business mailing address

3800 S OCEAN DR STE 209
HOLLYWOOD FL
33019-2915
US

V. Phone/Fax

Practice location:
  • Phone: 800-226-8874
  • Fax:
Mailing address:
  • Phone: 800-226-8874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9363228
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11012207
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: