Healthcare Provider Details

I. General information

NPI: 1528707817
Provider Name (Legal Business Name): INGRETT J MINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2736 HOLLYWOOD BLVD
HOLLYWOOD FL
33020-4808
US

IV. Provider business mailing address

10060 SHERIDAN ST APT 212
PEMBROKE PINES FL
33024-8547
US

V. Phone/Fax

Practice location:
  • Phone: 954-603-1881
  • Fax: 954-603-5341
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number6270
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: