Healthcare Provider Details

I. General information

NPI: 1285567156
Provider Name (Legal Business Name): PREMIUM PROVIDER SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5979 NW 151ST ST STE 237
MIAMI LAKES FL
33014-2434
US

IV. Provider business mailing address

5979 NW 151ST ST STE 237
MIAMI LAKES FL
33014-2434
US

V. Phone/Fax

Practice location:
  • Phone: 786-312-3834
  • Fax: 305-876-3189
Mailing address:
  • Phone: 786-312-3834
  • Fax: 305-876-3189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ELISELLY RODRIGUEZ
Title or Position: OWNER
Credential:
Phone: 786-312-3834