Healthcare Provider Details

I. General information

NPI: 1891336327
Provider Name (Legal Business Name): TONY BERNARD ANDERSON SR. N/A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2019
Last Update Date: 10/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20324 NW 36TH CT
MIAMI GARDENS FL
33056-1749
US

IV. Provider business mailing address

20324 NW 36TH CT
MIAMI GARDENS FL
33056-1749
US

V. Phone/Fax

Practice location:
  • Phone: 786-426-6250
  • Fax:
Mailing address:
  • Phone: 786-426-6250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: