Healthcare Provider Details

I. General information

NPI: 1629995857
Provider Name (Legal Business Name): PETIT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 NW 164TH ST
MIAMI FL
33169-6525
US

IV. Provider business mailing address

45 NW 164TH ST
MIAMI FL
33169-6525
US

V. Phone/Fax

Practice location:
  • Phone: 954-627-8650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PETIT AUGUSTIN
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 954-627-8650