Healthcare Provider Details

I. General information

NPI: 1407365364
Provider Name (Legal Business Name): MR. HILAIR BRICE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: HILAIRE BRICE RN

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 09/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

2250 BALSAN WAY
WELLINGTON FL
33414-6434
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-5495
  • Fax:
Mailing address:
  • Phone: 561-358-3669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number9243371
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number9243371
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: