Healthcare Provider Details

I. General information

NPI: 1023604378
Provider Name (Legal Business Name): MS. KAMILAH CUMMINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2020
Last Update Date: 12/20/2020
Certification Date: 12/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8652 NW 22ND AVE
MIAMI FL
33147-4173
US

IV. Provider business mailing address

2029 NW 87TH ST
MIAMI FL
33147-4233
US

V. Phone/Fax

Practice location:
  • Phone: 305-705-6077
  • Fax:
Mailing address:
  • Phone: 786-469-0677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number9432404
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9432404
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: