Healthcare Provider Details

I. General information

NPI: 1396837134
Provider Name (Legal Business Name): JMH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 08/22/2020
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

906 NW 111TH AVE
PLANTATION FL
33324-7367
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-6585
  • Fax:
Mailing address:
  • Phone: 954-476-6148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number1609412
License Number StateFL

VIII. Authorized Official

Name: MS. KATHY M DIGIOVANNI
Title or Position: STAFF CRNA
Credential: CRNA
Phone: 305-585-6586