Healthcare Provider Details

I. General information

NPI: 1295911444
Provider Name (Legal Business Name): AUDENE GARRISON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 NW 12TH AVE SUITE 1112
MIAMI FL
33136-1051
US

IV. Provider business mailing address

6270 NW 173RD ST 221
HIALEAH FL
33015-4551
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-1111
  • Fax:
Mailing address:
  • Phone: 305-951-0013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME95932
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME95932
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: