Healthcare Provider Details

I. General information

NPI: 1265894653
Provider Name (Legal Business Name): VENANTE ISME SERVALIS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 NW 27TH AVE STE D10
MIAMI FL
33147
US

IV. Provider business mailing address

5070 SW 163RD AVE
MIRAMAR FL
33027-4953
US

V. Phone/Fax

Practice location:
  • Phone: 305-403-4003
  • Fax: 305-403-4006
Mailing address:
  • Phone: 954-383-2824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9198815
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: