Healthcare Provider Details

I. General information

NPI: 1477824126
Provider Name (Legal Business Name): JEREMY TAYLOR BOYD NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 03/13/2021
Certification Date: 03/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 SW 172ND AVE
MIRAMAR FL
33029-5592
US

IV. Provider business mailing address

10843 LIMEBERRY DR
HOLLYWOOD FL
33026-4758
US

V. Phone/Fax

Practice location:
  • Phone: 954-538-5101
  • Fax:
Mailing address:
  • Phone: 305-301-1218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number783713
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: