Healthcare Provider Details

I. General information

NPI: 1477328318
Provider Name (Legal Business Name): TAMARA JEUDY PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 11/21/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1695 NW 9TH AVE
MIAMI FL
33136-1409
US

IV. Provider business mailing address

3261 NW 101ST AVE
SUNRISE FL
33351-6935
US

V. Phone/Fax

Practice location:
  • Phone: 954-607-9544
  • Fax:
Mailing address:
  • Phone: 954-607-9544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11029737
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: