Healthcare Provider Details

I. General information

NPI: 1528257276
Provider Name (Legal Business Name): DEWHURST MEDICALSERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 MERIDIAN AVE #7
MIAMI BEACH FL
33139-4545
US

IV. Provider business mailing address

1127 MERIDIAN AVE #7
MIAMI BEACH FL
33139-4545
US

V. Phone/Fax

Practice location:
  • Phone: 786-573-3397
  • Fax: 786-573-2367
Mailing address:
  • Phone: 786-573-3397
  • Fax: 786-573-2367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP3124292
License Number StateFL

VIII. Authorized Official

Name: MR. TYLER T DEWHURST
Title or Position: PRESIDENT
Credential: ARNP
Phone: 786-573-3397