Healthcare Provider Details

I. General information

NPI: 1295189140
Provider Name (Legal Business Name): TITE FAMILY PRACTICE AND SKIN CARE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2441 NW 7 ST
MIAMI FL
33125
US

IV. Provider business mailing address

2441 NW 7 ST
MIAMI FL
33125
US

V. Phone/Fax

Practice location:
  • Phone: 305-501-2804
  • Fax: 786-590-1080
Mailing address:
  • Phone: 305-501-2804
  • Fax: 786-590-1080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberARNP9227025
License Number StateFL

VIII. Authorized Official

Name: YOEL ENRIQUEZ
Title or Position: PRESIDENT
Credential: ARNP
Phone: 305-501-2804