Healthcare Provider Details

I. General information

NPI: 1477997153
Provider Name (Legal Business Name): FLORENCE JEAN MIAZGOWICZ MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 NW 15TH ST
MIAMI FL
33136-1431
US

IV. Provider business mailing address

750 NW 15TH ST
MIAMI FL
33136-1431
US

V. Phone/Fax

Practice location:
  • Phone: 305-325-1818
  • Fax: 305-325-1151
Mailing address:
  • Phone: 305-325-1818
  • Fax: 305-325-1151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: