Healthcare Provider Details

I. General information

NPI: 1174228076
Provider Name (Legal Business Name): ANAISE ELAINE PIERRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 US HIGHWAY 1 STE D
LAKE PARK FL
33403-3585
US

IV. Provider business mailing address

10300 SW 216TH ST
MIAMI FL
33190
US

V. Phone/Fax

Practice location:
  • Phone: 561-842-5900
  • Fax: 888-814-0879
Mailing address:
  • Phone: 305-254-4979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME175286
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: