Healthcare Provider Details

I. General information

NPI: 1770386518
Provider Name (Legal Business Name): JMJ HOLISTIC HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2025
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20348 NW 2ND AVE
MIAMI FL
33169-2503
US

IV. Provider business mailing address

PO BOX 298774
PEMBROKE PINES FL
33029-8774
US

V. Phone/Fax

Practice location:
  • Phone: 754-364-6154
  • Fax:
Mailing address:
  • Phone: 754-364-6154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MONIQUE MOISE
Title or Position: OWNER OF ENTITY
Credential:
Phone: 754-364-6154