Healthcare Provider Details

I. General information

NPI: 1295835692
Provider Name (Legal Business Name): JEANNINE ELAINE MORRIS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVENUE
MIAMI FL
33136
US

IV. Provider business mailing address

5135 SW 121 AVE
COOPER CITY FL
33330
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-5116
  • Fax:
Mailing address:
  • Phone: 954-815-0447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number3023722
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: