Healthcare Provider Details

I. General information

NPI: 1538126495
Provider Name (Legal Business Name): DAVID NEVINS AP, LCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19790 W DIXIE HWY STE 1208
MIAMI FL
33180-2548
US

IV. Provider business mailing address

19212 NE 25TH AVE 282
MIAMI FL
33180-3218
US

V. Phone/Fax

Practice location:
  • Phone: 305-725-1152
  • Fax:
Mailing address:
  • Phone: 305-725-1152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP 1529
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: