Healthcare Provider Details

I. General information

NPI: 1609080746
Provider Name (Legal Business Name): MIYVETTESHAUNE GREEN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 SW 37TH AVE STE 100-101
MIAMI FL
33133-2700
US

IV. Provider business mailing address

2890 W BROWARD BLVD UNIT B230
FT LAUDERDALE FL
33312-1263
US

V. Phone/Fax

Practice location:
  • Phone: 305-446-7277
  • Fax:
Mailing address:
  • Phone: 954-770-9219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number3314562
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3314562
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: