Healthcare Provider Details

I. General information

NPI: 1194029447
Provider Name (Legal Business Name): MISS MICHELLE M SENKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2010
Last Update Date: 12/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2455 HOLLYWOOD BLVD SUITE 215
HOLLYWOOD FL
33020-6605
US

IV. Provider business mailing address

2455 HOLLYWOOD BLVD SUITE 215
HOLLYWOOD FL
33020-6605
US

V. Phone/Fax

Practice location:
  • Phone: 954-453-1101
  • Fax: 954-453-1102
Mailing address:
  • Phone: 954-453-1101
  • Fax: 954-453-1102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number30211378
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: