Healthcare Provider Details

I. General information

NPI: 1154998292
Provider Name (Legal Business Name): JEREMY DUANE EADES ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 ALTON RD STE 540
MIAMI BEACH FL
33140-2842
US

IV. Provider business mailing address

19672 INDIAN MOUND DR
SUMMERLAND KEY FL
33042-3141
US

V. Phone/Fax

Practice location:
  • Phone: 305-731-8410
  • Fax:
Mailing address:
  • Phone: 305-731-8410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11013555
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: