Healthcare Provider Details

I. General information

NPI: 1578833927
Provider Name (Legal Business Name): ELIZABETH M. BODLE, A.R.N.P., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9220 SW 72ND ST SUITE 102
MIAMI FL
33173-3259
US

IV. Provider business mailing address

770 CLAUGHTON ISLAND DR APT 1015
MIAMI FL
33131-2617
US

V. Phone/Fax

Practice location:
  • Phone: 305-275-1700
  • Fax: 305-275-5008
Mailing address:
  • Phone: 305-275-5008
  • Fax: 305-275-5008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9266707
License Number StateFL

VIII. Authorized Official

Name: MISS ELIZABETH MARY BODLE
Title or Position: PRESIDENT
Credential: A.R.N.P.
Phone: 317-439-5924