Healthcare Provider Details

I. General information

NPI: 1770936197
Provider Name (Legal Business Name): MR. EVANS JAMERO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2527 JACKSON ST
HOLLYWOOD FL
33020-4930
US

IV. Provider business mailing address

2527 JACKSON ST
HOLLYWOOD FL
33020-4930
US

V. Phone/Fax

Practice location:
  • Phone: 954-628-5187
  • Fax:
Mailing address:
  • Phone: 786-487-9904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number310400000X
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: