Healthcare Provider Details

I. General information

NPI: 1750987277
Provider Name (Legal Business Name): ATLANTIS EDUCATIONAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 PARK CENTRE BLVD STE 102
MIAMI GARDENS FL
33169-5365
US

IV. Provider business mailing address

1111 PARK CENTRE BLVD STE 102
MIAMI GARDENS FL
33169-5365
US

V. Phone/Fax

Practice location:
  • Phone: 305-625-2112
  • Fax:
Mailing address:
  • Phone: 305-625-2112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: DIANA COWAN
Title or Position: REGISTERED NURSE EDUCATOR
Credential: RN
Phone: 305-625-2112