Healthcare Provider Details

I. General information

NPI: 1164531018
Provider Name (Legal Business Name): MRS. JACQUELINE REARDON CURTIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW 16TH ST PM&RS (117)
MIAMI FL
33125-1624
US

IV. Provider business mailing address

5851 HOLMBERG RD 1124
PARKLAND FL
33067-4536
US

V. Phone/Fax

Practice location:
  • Phone: 305-324-4455
  • Fax: 305-575-3415
Mailing address:
  • Phone: 954-757-8727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: