Healthcare Provider Details

I. General information

NPI: 1225276769
Provider Name (Legal Business Name): THAMAR MAURICE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 NW 183RD ST STE 120
MIAMI GARDENS FL
33169-4518
US

IV. Provider business mailing address

99 NW 183RD ST STE 120
MIAMI GARDENS FL
33169-4518
US

V. Phone/Fax

Practice location:
  • Phone: 786-446-7470
  • Fax: 786-434-6423
Mailing address:
  • Phone: 786-446-7470
  • Fax: 786-434-6423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number5182385
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11003272
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: