Healthcare Provider Details

I. General information

NPI: 1861798092
Provider Name (Legal Business Name): JENNIFER PROVINCE HONG ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2011
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 SW 72ND ST SUITE 212
SOUTH MIAMI FL
33143-4529
US

IV. Provider business mailing address

6701 SW 72ND ST SUITE 212
SOUTH MIAMI FL
33143-4529
US

V. Phone/Fax

Practice location:
  • Phone: 305-663-0710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP 9292024
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberARNP 9292024
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 9292024
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: