Healthcare Provider Details

I. General information

NPI: 1871228585
Provider Name (Legal Business Name): JOHN DURENA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 N 73RD TER
HOLLYWOOD FL
33024-7138
US

IV. Provider business mailing address

740 N 73RD TER
HOLLYWOOD FL
33024-7138
US

V. Phone/Fax

Practice location:
  • Phone: 786-803-2984
  • Fax:
Mailing address:
  • Phone: 786-803-2984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number9538797
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number9538797
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: