Healthcare Provider Details

I. General information

NPI: 1811566581
Provider Name (Legal Business Name): JERMILLA AUGUSTIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 N UNIVERSITY DR
TAMARAC FL
33321-2913
US

IV. Provider business mailing address

3621 NW 5TH PL
LAUDERHILL FL
33311-7517
US

V. Phone/Fax

Practice location:
  • Phone: 954-721-2200
  • Fax:
Mailing address:
  • Phone: 954-624-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11013288
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: