Healthcare Provider Details

I. General information

NPI: 1093414393
Provider Name (Legal Business Name): HIROMI CHU PABAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 NE 2ND AVE FL 3
MIAMI FL
33137-2706
US

IV. Provider business mailing address

17855 DALLAS PKWY STE 200
DALLAS TX
75287-6857
US

V. Phone/Fax

Practice location:
  • Phone: 305-762-3883
  • Fax:
Mailing address:
  • Phone: 346-376-1702
  • Fax: 224-532-2780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11024749
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: