Healthcare Provider Details

I. General information

NPI: 1285042176
Provider Name (Legal Business Name): ESTHER PHILISTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 07/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 NW 95TH ST
MIAMI FL
33150-2038
US

IV. Provider business mailing address

174 NW 102ND ST
MIAMI SHORES FL
33150-1232
US

V. Phone/Fax

Practice location:
  • Phone: 305-835-6000
  • Fax:
Mailing address:
  • Phone: 786-547-3726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9312239
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: