Healthcare Provider Details

I. General information

NPI: 1992329320
Provider Name (Legal Business Name): VISITING HEALTH SERVICES OF SOUTH FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 NW 166TH AVE
PEMBROKE PINES FL
33028-1341
US

IV. Provider business mailing address

1190 NW 166TH AVE
PEMBROKE PINES FL
33028-1341
US

V. Phone/Fax

Practice location:
  • Phone: 754-777-0794
  • Fax:
Mailing address:
  • Phone: 754-777-0794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALYSHA HENRY-JOHNSON
Title or Position: OWNER
Credential: PA-C
Phone: 754-777-0797